Human rights on rikers: Integrating a human rights-based framework for healthcare into New York City's jail system

The Bureau of Correctional Health Services (CHS) of the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) is responsible for all aspects of health care in the NYC jail system. In 2012, CHS adopted a healthcare framework that includes three equally important aims: patient safety, population health and human rights. The human rights component of this framework represents a new theoretical and operational endeavor for CHS, but is essential to fully addressing the needs of patients in the jail system. In order to integrate human rights into the healthcare systems operations, CHS has made three initial changes. First, the electronic health record (EHR) has been modified to allow providers and leadership to monitor health outcomes associated with vulnerable populations and human rights abuses, including injuries, mental health exacerbations in solitary confinement, and reports of sexual assault. Structured templates have been developed in the EHR that result in critical information being collected in a manner that both promotes the care of individual patients and also permits aggregate reporting and surveillance. Reports can focus on facility, pre-existing diagnoses, location of incidents, time of day, and many other variables. Reports are tailored for medical leadership, the Department of Correction (DOC), which is responsible for custody in the jail system, and outside partners. Second, a human rights subcommittee was created within the CHS quality assurance committee. The charge of this group is to assess areas of clinical care that may reflect human rights concerns; the first project is an assessment of dual loyalty in the jail system. Dual loyalty is the erosion of the health mission by the security demands of the correctional setting and is an omnipresent feature of correctional health. Data sources for this assessment include the EHR, patient complaints, patient interviews and a provider survey. This project will result in new training standards for all correctional health staff. The third aspect of the human rights framework is creation of a human rights collective. This collective meets every two months and elicits opinions and guidance from human rights and other policy or program experts on a single theme. The first two human rights collectives have addressed the nexus of intimate partner violence, sex work, and incarceration and the adverse health outcomes associated with solitary confinement. Discussion from these two meetings have contributed to new data analysis that is geared towards better patient care as well as influencing health policy.