Prison Medical Staff Research Articles

PREVALENCE AND ASSOCIATED FACTORS OF HUMAN SCABIES IN PRISONS IN DOSSO, NIGER

Scabies is a contagious, pruritic, cosmopolitan dermatosis, widespread especially in human communities, due to parasitism by a mite Sarcoptes scabiei var hominis A lack of hygiene and overcrowding inside the houses are favourable factors. The aim of our study was to determine the prevalence and factors associated with the occurrence of human scabies in the prison environment in Dosso (Niger). Prospective descriptive cross-sectional study conducted in November 2022 in the civil prison of Dosso on authorization of the prison administration. The collected data were sociodemographic characteristics, personal history of pruritus and its characteristics, risk factors related to hygiene and conditions of incarceration, examination performed by a dermatologist to look for clinical signs of scabies. The diagnosis was retained in any inmate presenting one or more elements at the interrogation and at the physical examination. Out of a total of 352 inmates, 43 (38 males and 5 females) had scabies, a prevalence of 12%. The average age was 33 with extremes of 18 and 62 years. Of the scabies patients, 9% reported a history of intense, sleepless pruritus prior to incarceration. Most of the inmates, 86%, were in cells with more than 20 inmates. Among those with scabies, 42% showered twice a day, 81% changed clothes after showering and 74% used soap regularly for washing. The topography of the lesions was external genitalia (37%), buttocks (21%), inner thighs (16%), interdigital spaces (9%), elbows (9%) and wrists (7%). The inmates were informed about the disease, treatment information was explained to them, and they attended a session on hygiene promotion. All cases of scabies detected were prescribed a local treatment based on benzyl benzoate lotion 25%. Human scabies is common in the prison environment in Dosso. Too often, scabies goes undetected and is confused with other pruritic dermatoses, such as eczema or atopic dermatitis. Prison medical staff should be trained in scabies in order to prevent scabies outbreaks. The authorities in the region should make the improvement of hygiene and detention conditions in prisons their priority.

Screening and treatment of hepatitis C virus in prisons: 10 years of experience

Introduction and objective: Two-thirds of patients with hepatitis C virus (HCV) infection are unaware of their infection in the European Union. The WHO aims to reduce the number of new cases of chronic hepatitis by 90% by 2030. The proportion of people infected with HCV in prisons can be up to ten times higher compared to the general population. This article is a summary of the results of the HCV screening carried out in the Hungarian prisons between 2007 and 2017. Method: Screening of anti-HCV antibodies has been performed on a voluntary basis followed by HCV PCR and genotyping in positive cases. After obtaining written informed consent from the patients, treatment was started. Treatments were performed under the guidance of hepatologists in collaboration with prison medical staff. Results: HCV screening programs and treatments are in place in 84% of Hungarian prisons. A total of 25 384 patients underwent anti-HCV screening. Anti-HCV positive result was detected in 6.6% and HCV PCR positivity was confirmed in 3.8% of the screened inmates. 55.2% patients from the HCV PCR positive population were put on treatment. Only 143 patients received full treatment, while 162 (42.6%) treatments were terminated prematurely, and the duration of treatment was unknown in 75 patients. Based on the results available on the 24th week after the end of treatment, sustained virologic response rate was 88%. Discussion: Education of patients and collaboration between hepatologists and prison medical staff play an important role in the successful result of treatment. Conclusion: Our experience demonstrates that the test and treat principle is feasible and effective at microeliminating HCV in prisons.

Improving participation of detained men in organised screening of colorectal cancer in Toulon

Abstract In France, organised screening for colorectal cancer was set up in 2008. Participation rate was assessed in March 2014 at the prison of Toulon / La Farlède. On the 100 detained men aged 50-74 years old concerned by screening, only 3.9 % were screened. A project aiming at improving participation in screening while addressing specific difficulties related to prison settings (lack of privacy in cells, low socioeconomic and education status of the population, stronger exposition to risk factors for colorectal cancer) was launched in 2015 and has been yearly conducted since then. How to improve colorectal cancer screening in a prison setting? How to organise a sustainable screening program? What proximity guidance should be provided to foster participation? The program that was developed mainly consisted in awareness sessions and proximity guidance to testing. Among the 330 detained men targeted between 2015 and 2018, 165 men performed an immunologic test (57.9%) and 45 were excluded for medical reasons. Colonoscopy was performed for 10 of the 13 men with a positive result and lesions were detected for 9 men. Among them, one cancer, 6 high-risk polyps and 2 low-risk polyps were found. Those findings exceeded expected numbers. Despite a small population sample, data revealed the benefit of the project in comparison with other participation rates: only 33.5% in France and 29.3% in the Var department (estimates for 2016-17 by Santé Publique France). Furthermore, we achieved a participation rate compliant with European recommendations establishing 45% as a minimum target. The success of our program relied on the synergy between health prevention professionals screening organisers and prison medical staff. Strong involvement of each team constituted a real leverage for project to ensure effective proximity guidance for detained persons leading them to get screened. Key messages Awareness program adapted to prison improved participation in colorectal cancer organised screening. Proximity guidance helped to detect cancer and to improve medical care of detained persons.

Medical malpractice cases involving lack of access to dermatologists for incarcerated patients in the United States from 1982 to 2018

While prison medicine is a heavily researched area for quality improvement, little is known regarding prisoner access to dermatologists. The goal of this study was to characterize the claims related to a lack of dermatologist access in prison malpractice cases. We searched the LexisNexis Academic database of legal records from 1970 to 2018 using the terms "medical malpractice and dermatologist" to yield federal malpractice cases involving dermatologists. Ultimately, 89 distinct cases in which a prisoner was not able to see a dermatologist were included in the final analysis. Data relating to year, location, anatomical site, symptoms, dermatologist related claim, specialty of treating physician, and final diagnosis were extracted for each case. The 89 cases involving prisoners who were not able to see a dermatologist for their skin condition ranged from 1982 to 2018, with California (n = 12) and Pennsylvania (n = 11) containing the largest number of cases. 76% of the prisoners were only treated by primary care prison physicians for their dermatologic concerns. Several issues regarding dermatologist access were categorized in this study. This study reveals limited access to dermatologists for prisoners in need of dermatologic care. Improved collaboration between prison officials, prison medical staff, and dermatologists could help improve prisoner care and limit malpractice risk.

Prenatal Education for State Prisoners Who Are Pregnant

Describe and evaluate a program of prenatal education for pregnant female prisoners in Georgia. Implement evidence-based prenatal education for pregnant female prisoners in the Georgia Department of Corrections. In collaboration with prison medical staff and leadership, a program of prenatal education was implemented for pregnant women. Weekly classes are taught by volunteers and cover a range of topics, including nutrition, management of pregnancy and childbirth discomforts, nonopioid pain-management strategies, postpartum recovery, as well as preparation for continued incarceration after childbirth. For 3 years, Motherhood Beyond Bars has provided prenatal education to more than 200 pregnant women incarcerated in the Georgia Department of Corrections. Measures of learning and collaboration with medical staff within the prison have been used to revise class content and expand the program. The provision of prenatal education to a high-risk, disadvantaged group of pregnant women who are incarcerated is an opportunity to improve health literacy and perinatal outcomes.

Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland.

Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.

Prevalence of Commonly Encountered Sexually Transmitted Infections Among Imprisoned Incarcerated Women

Background: Sexually transmitted infections are major causes of morbidity among incarcerated women. However, little is known about the prevalence of these infections among female prisoners in Iran. Objectives: This cross-sectional study, assessed the prevalence of sexually transmitted infections among a group of women imprisoned in Adelabad Prison, Shiraz, Iran. Patients and Methods: Over a 6-month period, we screened 129 female inmates in Adelabad Prison, Shiraz, Iran for sexually transmitted infections by appropriate clinical and routine laboratory assessments. Infected inmates were treated and followed up free of charge by the prison medical staff. Results: All inmates had evidence of at least one sexually transmitted infection. Chlamydial infection was the most common infection, which detected in 44 (34%) inmates, followed by candidiasis in 34 (26%), trichomoniasis in 26 (20%), syphilis in 8 (6%), and finally gonorrhea in 6 (4.5%) inmates. The least common infection was HIV infection, which was present in only 1 out of 129 subjects. In addition, 1 out of 58 (1.72%) serologically examined prisoners had hepatitis B, and 4 cases from 58 (7%) had evidence of hepatitis C, one of them was a drug addict and the other 3 had histories of past tattooing. Conclusions: Because of high rate of sexually transmitted infections (STIs) in incarcerated women, it is necessary to conduct a comprehensive screening program, treatment, follow-up, and partner notification in order to reduce the frequency of STIs in this high-risk, vulnerable group of females.

James McKenna, Farhat Manzoor and Greta Jones, Candles in the Dark: Medical Ethical Issues in Northern Ireland during the Troubles (London: Nuffield Trust, 2009), pp. v + 149, no price given, paperback, ISBN: 978-1-905030-32-3.

This is an important book that will appeal, not only to historians of medicine, but to social historians and those interested in the history of the Troubles in Northern Ireland. The authors have given an insightful account, which at times makes difficult reading, but which, nevertheless, is significant in its contribution to the history of the Troubles, encompassing the period from 1969 until the second ceasefire in 1998. The research conducted for this book is a momentous achievement: the authors conducted oral history interviews with over two hundred people over a three-year period, with the chief objective of trying to find out how difficult it was to conduct medical work in Northern Ireland in the period, and ‘to maintain the medical codes of ethics governing health care’ (p. 2). The interviewees consisted of health professionals, patients, ex-prisoners and medical staff working in prisons. The authors draw attention to the particular problems of oral history in the case of Northern Ireland, but in spite of these, the book as a whole gives a balanced view of the issues of both sides of the Divide, and the oral history accounts are compelling and give a personal insight into the experiences of men and women during the Troubles. Following the introduction and a chapter on the background to the history of the Troubles in Northern Ireland, the main part of the book opens with two chapters that deal with the experiences of health professionals and patients. The first of these examines the effects of the Troubles on the work of general practitioners in Northern Ireland in the period, in particular, focusing on the difficulties that they encountered while trying to go about their daily work, such as unofficial roadblocks and the increased demand on mental health skills. In addition, the chapter examines the effects on patients, such as the difficulties they experienced in travelling to hospital and how their political and religious persuasions may have affected their choice of hospital and/or GP. The next chapter gives an insight into the particular problems that hospital staff and patients had to contend with during the Troubles. Notably, Northern Irish hospitals, such as the Mater Infirmorum, which straddles ‘one of the most fraught community interfaces in Belfast’, witnessed a great deal of civil strife and violence during the Troubles (p. 43). The chapter also addresses the issues of staff and patient security in Northern Irish hospitals in the period, indicating how these factors ‘complicated the lives of medical professionals and intruded directly on the delivery of medical care’ (p. 63). The final two chapters deal with the issue of medical care in prisons during the Troubles. The first of these is largely based on the allegations of prisoners and gives an insight into the effects of the Troubles on both prisoners and prison doctors during the period. The final chapter deals with the topic of ‘Prison Protests’, in particular, focusing on the ‘Dirty Protest’ and the strain it placed on medical services. This chapter was well balanced, and gave adequate focus to the experiences of prison medical staff, the stories of whom are often neglected in broader histories of the Troubles. Doctors working in prisons were targets for assassination on the outside, and the type of work they experienced resulted in consequences for their mental health, with one senior doctor, ‘Dr P’, who nursed most of the hunger strikers, representing a victim of this and committing suicide, arguably as a result of the pressures of his job (pp. 105-6). This book is a significant contribution to the history of Northern Ireland, examining the history of the Troubles from the perspective of those delivering and receiving medical care. The oral history accounts which form the basis of the book will represent a valuable historical resource for future generations of historians.

Risk factors for developing tuberculosis in remand prisons in St. Petersburg, Russia — a case-control study

Detainees have a substantial risk to develop tuberculosis (TB) due to a higher incidence of TB in remand prison compared to the civil community. They develop TB during incarceration not only due to poor living conditions in remand prison, but also due to some factors affecting their life before imprisonment. Prevention measures against TB spread from penitentiary institutions to society include study of factors, which contribute to TB development. Current study aims at identification of important risk factors of TB development in remand prison in St. Petersburg, Russia. A retrospective matched case-control study was performed from May 2002 to May 2003 in two remand prisons in St. Petersburg. One hundred and fourteen prisoners (57 cases, 57 controls) were interviewed by using standardised questionnaire. Logistic regression analysis was performed to identify risk factors. Six factors were significantly linked to the risk of developing TB: narcotic drug use (odds ratio (OR): 2.6, 95% confidence interval (CI): 1.0-6.9), low income (OR: 3.2, CI: 1.2-8.6), high ratio of prisoners per available bed (OR: 4.0, CI: 1.1-15.0), not having own bed clothes (OR: 13.0, CI: 2.7-61.6), and little time outdoors (OR: 3.3, CI: 1.3-8.5). However, good housing before imprisonment (OR: 4.2, CI: 1.1-15.7) was a separate risk factor for TB. Three of the risk factors (high number of prisoners per bed, not having own bed clothes, and little time outdoors) are certainly possible to approach by improvement of conditions in remand prisons. The remaining three factors (narcotic drug use, good housing before imprisonment, and low income) provide knowledge about study population, but cannot be intervened by prison's medical staff.

Roell v. Withrow, 123 S.Ct. 1696 (2003), and the Federal Magistrate Act of 1979

In an effort to ease the burden on the federal judiciary of mounting caseloads, the Federal Magistrate Act of 1979 authorizes magistrate judges to "conduct any or all proceedings in a jury or nonjury civil matter and order the entry of judgment in the case, when spe cially designated-by the district court" and when acting "[u]pon the consent of the par ties." 28 U.S.C. 636(c)(1) (1979). Since President Carter signed the act into law, mag istrate judges have been hearing more and more matters in the district courts. In fact, without the availability of magistrate judges to preside over a wide-ranging variety of proceedings, the federal judiciary would likely be overwhelmed. The use of magistrate judges is not limitless. Before a magistrate judge may pre side over a civil trial, both parties must affirmatively elect to forgo their right to have an Article III judge hear the matter. While the procedures for this consideration and accep tance are perceived as mere formalities, in Roell v. Withrow, 123 S.Ct. 1696 (2003), the Supreme Court was faced with a classic judicial dilemma in statutory interpretation and the enforcement of rules of procedure: mandating strict enforcement of a procedural rule that would give rise to an "unjust" result, or interpreting the intent of Congress in enact ing a statute to discount a "technical omission" and lead to the result Congress surely intended. Jon Withrow, a Texas state prisoner, brought an action under 42 U.S.C. 1983 against three members of the prison's medical staff (Roell, Reagan, and Garibay), alleg ing that they had deliberately disregarded his medical needs in violation of the Eighth Amendment. During a preliminary hearing the presiding magistrate judge told the par ties that they could have her rather than the district judge preside over the entire case. While Withrow agreed orally (and later in writing), the Texas attorney general's office stated that they would consider the option and respond in writing. Without waiting for the attorney general's response, the district judge referred the case to the magistrate judge for final disposition, pursuant to the Federal Magistrates Act. The referral included the caveat that "all defendants be given an opportunity to consent to the jurisdiction of the magistrate judge, " and that the referral order would be vacated if any of the defendants did not consent as required by 28 U.S.C. 636(c)(l). Defendant Reagan, who was represented by private counsel, gave written consent to the referral. Defendants Roell and Garibay, who were represented by the attorney general's office, did not respond to the referral.

Training in prison psychiatry

Training in psychiatric work in prisons may not always receive adequate attention, as highlighted in the Reed Report (Department of Health and Home Office, 1992). As a first step in addressing this, a one-day induction procedure has been added to the Induction Programme for the Forensic Senior Registrars at the Regional Secure Unit (RSU) in Bristol. The contents of the programme were determined by discussion among prison medical staff, the Training Department and Forensic Senior Registrars, and are outlined in the following timetable:

Resource requirements in forensic psychiatry

Abstract Last week I saw Michael in an “unfurnished room’ at my local prison. He was becoming dehydrated, and the cell walls were decorated with a mixture of his blood and faeces. Despite his florid psychosis, he recognized me from a previous admission, and he pleaded with me to get him out. Instead, I encouraged the prison medical staff to administer intra-muscular neuroleptics under common law. There was no available bed in the specialist resource that he required.