Beyond compassionate release

Background

Compassionate release is the process by which certain seriously ill prisoners are allowed to die in the community prior to completing their sentence. A form of health-based advocacy, compassionate release (CR) has received increased attention in light of challenges posed by an aging prison population and the rising cost of the criminal justice system. However, compassionate release remains a late-stage, time-consuming and infrequently successful process. Less well defined is the potential contribution of health-based advocacy for detainees in jails who are awaiting trial or sentencing. Patients with serious illness often cannot fully participate in court proceedings, and jails have intrinsically greater flux than the prison system leaving them poorly equipped to care for seriously ill or dying patients. For these reasons, health-based advocacy in the jail system occurs frequently, but the exact nature and value of the work remains poorly understood.

Objective

To better understand health-based advocacy in the jail system.

Methods

There were 58 letters written by the medical director on behalf of detainees in the NYC jails from September 2010 through July 2013. These letters were reviewed and categorized according to the objective of the letter. The prevalence of cited disease processes was noted for each.

Results

Of the 58 letters reviewed, 21% were for patients with serious illness requesting CR; 40% were for patients with serious illness not requesting CR and 26% confirmed diagnosis appropriate for structured alternative to incarceration. A small percentage (<5%) described catastrophic illness diagnosed in jail and conditions difficult to treat in jail setting. Regarding common diseases, 41% of patients had cancer, 22% of patients had HIV/AIDS and 17% had substance abuse documented.

Discussion

In the case of compassionate release, medical information is clearly relevant to the criminal justice process. These letters suggest that this may be true in many other situations, and the nature and scope of the information deemed relevant may vary in a detainee population versus prison. Requests for medical information to be provided to the court come from many sources including patients, defense attorneys, judges, correctional officials and treating physicians. Though medical information is often communicated, analysis reveals that in our system most letters are not formal requests for CR. Better understanding the ways in which medical information can be useful to the courts would allow correctional health providers to better align with the criminal justice system in providing safe, effective sentencing options for detained patients.