Independent review of clinical health services for prisoners.

Abstract

The purpose of this paper is to describe the parameters for the development of performance measurement of the quality of medical care behind bars, drawing from widely-published free-world clinical guidelines and aspects of care that are unique to the criminal justice arena. One way to help assure that prisoners receive timely and appropriate health care is through independent review of health care services, to identify strengths of programs and opportunities for improvement. This is a quality of medical care assessment. When done in a systematic way, this has the potential to reduce risk of harm and enhance the personal health of the prisoner and improve the public health. Independent external review provides the best opportunity to identify and remedy opportunities for improvement. "External" can mean wholly independent or "corporate," that is, review by agency staff that has no vested interest in the findings at the individual facility. Recently, the methodology for assessment of the quality of medical care in the community has blossomed, yet there is little guidance on how to adapt this methodology to the prison setting. This paper introduces a prison-oriented method for assessing clinical performance. To the extent possible, the author cites references to the scientific basis for the recommendations. Where there is no science, the author relies as much as possible on consensus, and in a few cases resorts to "wisdom and experience," as unreliable as this might be. This is a conceptual paper with a viewpoint. The paper provides guidance on reducing risk of harm and promoting improved health and health care for prisoners.