Triaged Out of Care: How Carceral Logics Complicate a 'Course of Care' in Solitary Confinement.

Melissa Barragan,Keramet Reiter,Dallas Augustine,Kelsie Chesnut,Natalie A Pifer,Justin Donald Strong,Gabriela Gonzalez

doi:10.3390/healthcare10020289

Abstract

Incarceration, along with its most restrictive iteration, solitary confinement, is an increasingly common experience in America. More than two million Americans are currently incarcerated, and at least one-fifth of incarcerated people will experience solitary confinement. Understanding the barriers to care people experience in prison, and especially in solitary confinement, is key to improving their access to care during and after incarceration. Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two key barriers to care that people in solitary confinement face: cultural barriers (assumptions that incarcerated people do not need or do not deserve care) and structural barriers (physical spaces and policies that make contacting a healthcare provider difficult). While scholarship has documented both the negative health consequences of solitary confinement and correctional healthcare providers’ challenges navigating between the “dual loyalty” of patient care and security missions, especially within solitary confinement, few have documented the specific mechanisms by which people in solitary confinement are repeatedly triaged out of healthcare access. Understanding these barriers to care is critical not only to improving correctional healthcare delivery but also to improving healthcare access for millions of formerly incarcerated people who have likely had negative experiences seeking healthcare in prison, especially if they were in solitary confinement.

Highlights

In prisons, healthcare is provided at the intersection of individuals’ needs and institutional security restrictions
Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two categories of barriers that stymie both the provision and quality of care that people in solitary confinement receive: cultural barriers and structural barriers
Willing participants were escorted one-by-one to a confidential area, consented, and interviewed by one or two members of the research team. (For additional steps taken to protect vulnerable imprisoned research participants and details of the training research team members completed, see Appendix A of Reiter et al, 2020 [33].) In all, 106 incarcerated people participated in interviews; 39 percent of those approached for participation refused, which is comparable to similar studies of incarcerated people [34,35]

Summary

Introduction

Healthcare is provided at the intersection of individuals’ needs and institutional security restrictions. You know, the spray, or the [cell extraction] shield.—Kelly [pseudonyms have been assigned to all interview participants to ensure anonymity], Nurse. As the following correctional healthcare worker notes, routine intake assessments conducted by medical staff when admitting a person to a solitary confinement unit are used to both identify health needs and determine a person’s suitability for possible uses of force: No matter where they come from [before arriving in solitary confinement], if there’s no injuries, I still have to do an intake questionnaire and assess whether or not they can be OC’d [be sprayed with oleoresin capsicum vapor] . In this example, and in the many to follow in this article, security needs are given equal priority with, or even treated as superseding, individuals’ healthcare needs, creating barriers to care that impact all parties involved in both the delivery and receipt of care—. Because racial minorities are disproportionately likely to experience incarceration in the United States, the experience of incarceration itself is considered a negative social determinant of health, especially for Black men [6]

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Conclusion