Jail and Prison Health Care Standards

A Determination of Need without Reference to Want or Desire
  • Nancy Neveloff Dubler
Part of the The Hastings Center Series in Ethics book series (HCSE)


Delivering health care in a jail or prison is delivering care in a “non-health-care space.” Health care professionals must diagnose, treat, care for, and comfort in an institution designed to confine, humiliate, infantilize, punish, and reform. The intrinsic conflict between the goals of a health care delivery system and the goals of penal institutions has historically produced and continues now to create most severe tensions in the interactions between correctional personnel and health care providers and it also challenges the relationship usually assumed to exist between providers and their patients.


Health Care Delivery System Federal Court Correctional Official Inmate Population Correctional Institution 
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  1. 1.
    For a general discussion of the growth and development of the modern penitentiary, see Michael Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution, 1750–1850 (New York: Pantheon Books, 1978).Google Scholar
  2. 2.
    Ibid., p. 100.Google Scholar
  3. 3.
    Ibid., p. 60.Google Scholar
  4. 4.
    Census of Jails and Survey of Jail Inmates, 1978,” National Prisoner Statistics Bulletin, No. FD-NPS-J-6P (February), 1979.Google Scholar
  5. 5.
    Newman v. Alabama, 349 F. Suppl. 278, 503 F. 2d, 1320 (5th Cir. 1974), Cert, denied 421 U.S. 948.Google Scholar
  6. 6.
    For the abandonment of the hands-off doctrine, see Procunier v. Martinez, 416 U.S. 396, 404 (1973). “traditionally, federal courts have adopted a broad hands-off attitude toward problems of prison administration…. Suffice it to say that problems of prisons in America are complex and intractable and more to the point, they are not readily susceptible of resolution by decree… but a policy of judicial restraint cannot encompass any failure to take cognizance of valid constitutional claims whether arising in a federal or state institution. When a prison regulation or practice offends a fundamental constitutional guarantee, federal courts will discharge their duty to protect constitutional rights.”Google Scholar
  7. 7.
    The linguistic war was finally won by the phrase “deliberate indifference,” the language endorsed by the Supreme Court in Estelle v. Gamble, 429 U.S., 97, (1976), at 106:” Deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain’… proscribed by the Eighth Amendment. This is true whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards in intentionally denying or delaying access to medical care or intentionally interfering with the treatment once proscribed. Regardless of how evidenced, deliberate indifference to a prisoner’s serious illness or injury states a cause of action under section 1983 429 U.S. at 104–05. The deliberate indifference standard, however, was clarified by the Court to include only ‘wanton infliction of unnecessary pain’ and not an accident or inadverdent failure: Thus, a complaint that a physician has been negligent in diagnosing or treating a medical condition does not state a valid claim of medical mistreatment under the Eighth Amendment. Medical malpractice does not become a constitutional violation merely because the victim is a prisoner. In order to state a cognizable claim, a prisoner must allege acts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs. It is only such indifference that can offend ‘evolving standards of decency’ in violation of the Eighth Amendment” (429 U.S. at 106).Google Scholar
  8. 8.
    U.S. Department of Justice, Law Enforcement Assistance Administration, National Criminal Justice Information and Statistics Service, 1970 National Jail Census (Washington, D.C.: U.S. Government Printing Office, February, 1971).Google Scholar
  9. 9.
    Medical Care in U.S. Jails—A 1972 AMA Survey (Chicago: AMA Division of Medical Practice, Februarv, 1973), forward.Google Scholar
  10. 10.
  11. 11.
    bid., pp. ii and iii.Google Scholar
  12. 12.
  13. 13.
    Ibid., p. 1.Google Scholar
  14. 14.
    Ibid., p. 4.Google Scholar
  15. 15.
    B. Jaye Anno and Carlton A. Hornung, “Summary of an Evaluation of the American Medical Association’s Program to Improve Health Care in Jails” (paper presented at the Second National Workshop on Criminal Justice Evaluation, September, 1978), p. 6.Google Scholar
  16. 16.
    Robert L. Brutsche, “Medical Standards for Corrections: A Status Report.” Corrections Today, July-August, 1979. 17 Judith Resnik and Nancy Shaw, “Prisoners of Their Sex, Health Problems of Incarcerated Women,” A Prisoners Rights Source Book: Theory, Litigation and Practice, Vol. II. edited by Ira Robbins (New York: Clark Boardman, Inc. 1980), p. 77. 18 Ibid., p. 76.Google Scholar
  17. 19.
    Standards for Health Services in CorrectionalInstitutions, An Official Report of the American Public Health Association (Washington, D.C.: American Public Health Association, 1976); Health Care in Correctional Institutions, Prescriptive Package (Washington, D.C: Law Enforcement Assistance Administration, U.S. Department of Justice, 1975).Google Scholar
  18. 20.
    Standards for Health Services in Jails, AMA Program to Improve Medical Care and Health Services in Correctional Institutions (Chicago: AMA Division of Medical Practice, July 1979), preface p. i.Google Scholar
  19. 21.
    Ibid., p. 25.Google Scholar
  20. 22.
    Ibid., p. 30.Google Scholar
  21. 23.
    Anno and Hornung, “Summary,” p. 17.Google Scholar
  22. 24.
    Ibid., p. 19.Google Scholar

Copyright information

© The Hastings Center 1983

Authors and Affiliations

  • Nancy Neveloff Dubler
    • 1
  1. 1.Department of Social MedicineMontefiore Medical CenterNew YorkUSA

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