Public Health Law Map - Beta 5 - Medical and Public Health Law Site

Introduction
autonomy, within the bounds of prison regulations.
Prisoners have the right to consent to and refuse medical care, but these rights are
limited.
Team physicians must always put the interests of the player first.
Team and school physicians must be aware of the special duties involved in
treating minors.
School physicians must respect their patient’s privacy and the parents’ right to
oversee their children’s care.
Institutional practitioners are medical care practitioners who work for an entity whose
interests are sometimes adverse to their patients’ interests. The most common
institutional practice is occupational medicine. This section discusses prisons, sports
teams, and schools. These represent a continuum, with prisons having the greatest
conflict between the institution and the patients, and schools having the least. When
medical care practitioners practicing in these environments balance their duty to the
patient against their duty to the institution and the community, they must not confuse
public safety issues with institutional convenience. For example, prison health care
practitioners should not drug patients just to keep them quiet, but must not hesitate in
diagnosing and treating communicable diseases that may spread in the prison setting.
School physicians face the same dilemma when requested to recommend Ritalin to quiet
an unruly student.
The team and school physicians share the conflict between institutional obligations and
the fiduciary duty to the individual patient. This conflict is exacerbated because many
patients are unable to make knowing choices of treatment. Often the patients are minors.
In others, the coercive atmosphere of team sports makes it difficult for individual
athletes to resist the pressure to compete when it is medically inadvisable. School and
team physicians must be careful to protect their adult patients’ autonomy. When the
patient is a minor, the physician may have to intercede to protect the child from the
pressure of overly competitive parents and coaches.
A. The Prison Doctor
Over the last 30 years, the role of prison physicians has changed dramatically. Being
the doctor for the county jail used to be a relatively easy job. The position was
frequently filled by a physician who had retired from private practice. Prisoners were
viewed as having little right to medical care, and there was not much concern about its
quality. Even incompetent physicians were usually immune from suits for medical
malpractice because, as governmental employees, they enjoyed immunity for many of
their actions.
Prisons are now highly regulated. (This section will use prison as a generic term for all
correctional and detention facilities.) State and federal court cases, combined with
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