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

hearing seems to be rooted in the limited autonomy granted to prisoners. The Court
found that a prisoner’s right to refuse antipsychotic medication was limited by the
conditions of his confinement. In particular, the Court found that the purpose of the
prison’s medication policy was “to diagnose and treat convicted felons, with the
desired goal being that they will recover to the point where they can function in a
normal prison environment.”
The Court in Harper balanced the prisoner’s best interests against the prison’s
interest in returning him to the general prisoner population and his punishment.
The role of the expert decision maker, the prison psychiatrist, was to ensure that the
prisoner was mentally ill and dangerous and that medication was appropriate to
remedying these conditions. The protection of the prisoner’s interests was left to
the integrity of the prison psychiatrist. The Court’s finding that expert decision
making satisfied the prisoner’s due process interests reflects the Court’s general
reticence to interfere in matters of prison safety and security.
Prisoners retain some right to refuse medical care after Harper, but this is severely
circumscribed as compared with the rights of a nonprisoner patient. Prisoners may
not refuse testing or treatment for a condition that would threaten the health and
safety of the prison community, these including communicable diseases and
treatable psychiatric conditions. Prisoners may also be forced to accept treatment
that is necessary to protect their health from permanent injury. Prisoners with
religious objections to medical treatment may be treated against these objections if
the treatment is necessary to preserve prison discipline.
For prisoners in Federal Bureau of Prisons facilities, there are specific regulations
governing care provided without or against the prisoner’s informed consent. These
regulations deal with a specific judicial process for such care involving infectious
diseases or mental illness. There are also provisions for emergency care. Although
these regulations may not apply in other facilities, they set a medical and a legal
standard for handling such cases that state and local correctional facilities would be
wise to adopt or adapt to their specific situations.
c) Emergency Medical Care
The weakest part of most jail medical programs, especially small programs without
full- time physician supervision, is the evaluation and treatment of acute injuries
and illnesses. These are most common in the drunk tank: a large room where those
who are intoxicated and other prisoners are held until they post bond. The drunk
tank is an ongoing source of unnecessary deaths and accompanying liability suits
against local governments and physicians. Neither police officers nor physicians
can visually distinguish an intoxicated prisoner with a mild bump on his head from
a severe head injury patient who has had a couple of drinks. Diabetic coma and a
drunken stupor look and smell very much alike. Most physicians know this; most
police officers do not.
Considering the extent to which alcohol is involved in traffic accidents and crimes
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