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Abstract #152662

Nicole F. Masenior, MHS¹, Chris Beyrer, MD, MPH², Jason Gerson, PhD Candidate³, Deborah M. Golden, JD⁴, Philip Fornaci, JD⁴, John A. Zambrano, MHS⁵, and Julie S. Mair, JD, MPH⁶. (1) Department of Epidemiology, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, 443-287-7277, nfranck@jhsph.edu, (2) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E7152, Baltimore, MD 21205, (3) Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N. Broadway, Room 348, Baltimore, MD 21205, (4) D.C. Prisoners' Project, Washington Lawyers' Committee for Civil Rights and Urban Affairs, 11 Dupont Circle, NW, Suite 400, Washington, DC 20036, (5) RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, (6) Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 5th Floor, Baltimore, MD 21205

Purpose/Rationale: The purpose of this study was to investigate allegations of limited access to HIV/AIDS medications and other necessary prescription medications among detained women at the two jail facilities in the District of Columbia. The removal of a cap on the facilities' population, the absence of on-site monitoring of the jails' conditions, and the subsequent complaints from the incarcerated about the general unresponsiveness of the staff to their health needs prompted investigators to assess the timeliness and appropriateness of health care service delivery. Study Design, Setting and Sample: This study was a semi-structured cross-sectional health survey of 111 women held at the DC Jail and Correctional Treatment Facility from October 2004 to April 2005. To minimize any potential risks to inmates, interviews were conducted by lawyers under the shield of attorney-client privilege. Investigators neither sought the permission of the facility nor did they attempt to access inmates' medical records. Results: Thirty-seven percent of the women reported having a medical condition prior to their current incarceration period and 17 percent reported having more than one condition. Within this group, 52 percent reported problems with health care access as a result of being incarcerated. Delays in treatment were most common among women with chronic conditions (62%), and longest for women requiring psychiatric treatment (range: 178-300 days). 75 percent of the women reporting to have HIV/AIDS (n=13) reported significant delays, interruptions and discontinuation of medications. Conclusion: This study identified clear and systematic delays in access to health care and prescription medications. These delays and denials of needed care are found across all categories of illness—chronic, infectious, and mental health—but they appear to most prevalent among women with chronic diseases, and especially grievous for women needing treatment for HIV/AIDS. These access issues do not appear to improve over time and cannot be ascribed simply to high turnover rates or short-term delays. The implications of treatment lapses will vary with disease, stage and age, but drug resistance for infectious disease treatments, and irreversible damage due to a lack of chronic care will be common results for women with serious illness. We argue that the failure of government agencies to provide needed health services to people under their direct care is an abrogation of their responsibilities and constitutes a violation of the basic human right to a minimum standard of access to health care.

Learning Objectives:

• Recognize that treatment denials and delays can result in unnecessary suffering, affronts to dignity, and can lead to health complications and increased morbidities for individuals, their families, and their communities upon release.
• Discuss why denials and delays of medical and mental health care to incarcerated populations should be considered human rights violations.
• Recognize that timely treatment for incarcerated women would improve the safety and working conditions of corrections facility staff.

Keywords: Access and Services, Jails and Prisons

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.