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

ates among drug addicts.
Beyond these common diseases, prison physicians should work with local health
authorities to determine which other communicable diseases are prevalent in their
prison population. Ideally, prisoners with inadequate immunization histories would
be immunized against tetanus, measles, and other childhood diseases. An admission
physical should also screen for chronic diseases or conditions that might cause
problems if they remain untreated. Since work will be part of prison life in most
cases, the prison physician should look for any disabling conditions that might
require special consideration. Just as prisoners are entitled to expect reasonable care
for acute problems, they are entitled to expect that their prison work will not
endanger their health.
It is wise for any jail or prison to have comprehensive policies for control of certain
communicable diseases, particularly tuberculosis, hepatitis, and HIV. Without formal
policies, decisions tend to be made in the heat of the moment on nonmedical
grounds. This ad hoc disease control is usually ineffective and can be expensive. For
instance, if there is no policy for immunizing staff against hepatitis and no
determination of who is at risk for contracting hepatitis, then there is likely to be a
large demand for gamma globulin shots every time a prisoner develops jaundice. In
addition to the cost of the shots, the institution that perpetuates the myth that hepatitis
can be spread by casual contact may find itself paying for every case of communityacquired
hepatitis among its employees as a workers’ compensation claim.
Prison communicable disease policies should be developed in conjunction with state
and local public health authorities. In most instances, the prison physician is not
exempt from the communicable disease control laws of the state, including reporting
laws. Telling the county sheriff that there is tuberculosis in the jail is not the same as
telling the county health officer. As a practical matter, the prisoner and his or her
disease is probably well known to the local public health clinics. Getting current
records can save a lot of time, effort, and money.
Communicable disease control policies must protect inmates from infection while
not unduly interfering with the rights of the infected prisoners. HIV- infected
prisoners must be identified to ensure that they receive proper preventive medical
care, but there are no disease control justifications for isolating them unless they pose
a risk of sexual assault to other prisoners. In contrast to HIV, tuberculosis is a severe
problem in prisons and demands both aggressive investigation of outbreaks and the
isolation of infectious prisoners. The federal courts have found that failing to protect
prisoners from tuberculosis violates the requirements of the U.S. Constitution. The
National Center for Prevention Services of the Centers for Disease Control and
Prevention has prepared a monograph “Controlling TB in Correctional Facilities,”
which should be part of every correctional medicine program.
4. The Physician’s Obligations to the Jailers
As with other institutional settings, physicians should request a written description of
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