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

legislation, set minimum standards for medical care in prisons and jails. The first effect
of these standards was to end most medical experiments on prisoners. In addition, the
standards ensure that inmates receive adequate medical care and make it easier to sue
physicians and others involved in improperly run prison medical programs. Despite
these regulations, prison conditions are deteriorating in many parts of the country.
Prisons are overcrowded, and inmates are increasingly HIV infected secondary to the
drug abuse that may have led to their incarceration.
1. Prison Medical Care
Our most fundamental constitutional right is that no person may be deprived of life,
liberty, or property without due process of law. When an individual is deprived of
liberty by the state, the state assumes the responsibility for caring for the basic needs
of that individual. A prisoner is unable to go out and get food and water, so the state
must provide it. If the state did not provide it, the prisoner would be deprived of life.
This is also the basis for a prisoner’s right to medical care: a prisoner deprived of
necessary medical care may be deprived of life or health. It is the extent of this
constitutional right to care that is at issue.
The legal standard for judging the adequacy of prison medical care delivered by state
employees is whether there is a deliberate indifference to the prisoners’ welfare.
(Medical care practitioners who work for private contractors are liable for ordinary
malpractice.) The prisoner need not show that the prison officials intend harm
through inadequate or improper medical care. A mere showing of malpractice is not
enough, however. The legal standard for prison medical care is much lower than the
standard for free persons. This poses an ethical dilemma for prison medical care
practitioners: when is it ethically permissible to provide lower- quality medical care
for prisoners? Although the easy answer is “never,” there are few prisons that will
fund community standard medical care for prisoners. Is it unethical for physicians to
work for these institutions, or is it better to provide the care that is possible under the
limited circumstances?
a) Physician–Prisoner Relationship
The physician–prisoner relationship is different from the traditional physician–
patient relationship. The physician–prisoner relationship is not a fiduciary
relationship. Legally, it most closely resembles the relationship between a public
health physician and a patient. In both cases, the physician’s first duty is to the
health and safety of the community rather than to the patient. Prison officials have
broad discretion to preserve order in the prison. Prisoners lose most of their rights
to privacy along with their liberty. Prison officials have a right to any information a
physician may obtain that would affect the health and safety of the prison
community.
Although prisoners have little expectation of privacy, they do have an expectation
that their physician will exercise independent medical judgment regarding the
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