Denials and delays: Limits on the right to health care among incarcerated women in the District of Columbia women's jails, 2004-2005

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.