On October 14, 2007, the National Commission on Correctional Health Care (NCCHC) issued a position paper in response to the abuse of prisoners. The NCCHC is an organization dedicated to improving professionalism and safety in the jails and prisons by establishing national standards, accreditation, litigation and public openness. The paper condemns the abuse and/or torture of prisoners and calls upon health professionals to report such incidents.
In its 2003 Standards for Health Services in Prisons, the NCCHC precludes health staff directly participating in prisoners’ non-medical restraint or isolation (P-I-01 Use of Restraint and Seclusion in Correctional Facilities). Other standards require the informed consent of prisoners patients for “all examinations, treatments and procedures” (P-I-05 Informed Consent), recognize the patient’s right to refuse treatment (P-I-06 Right to Refuse Treatment), protect prisoners human medical research subjects (P-I-07 Medical and Other Research), require independence in clinical decisions (P-A-03 Medical Autonomy), protect the privacy of medical records (P-H-02 Confidentiality of Health Records and Information) and the privacy of prisoner health care (P-A-09 Privacy of Care). Standards also require documentation of patients’ health status at each encounter with health staff (P-H-04 Availability and Use of Health Records) and pay special attention to the medical and mental health of prisoners in segregation (P-E-09 Segregated Inmates).
The position paper acknowledges that the previous standards did not address the situation in which a health professional is instructed to directly or indirectly participate in or witnesses the abuse of a prisoner or becomes aware of such abuse because of its medical or mental health consequences. Therefore, it sets forth standards for the conduct of health professionals when they encounter prisoner abuse. For instance, correctional health care professionals are instructed not to “condone or participate in cruel, inhumane, or degrading treatment” of prisoners and when such behavior is seen or suspected to “identify and report” it to the “appropriate authorities.” Unfortunately, it does not identify who such “appropriate authorities” are, which could result in the report going into the same chain of command that ordered the abuse. Health care professionals are also told to “refrain from participating, directly or indirectly, in efforts to certify inmates as medically or psychologically fit to be subjected to abusive treatment.” They are instructed to “refrain from being present in the interrogation room, asking or suggesting questions, or advising authorities on the use of specific techniques of interrogation” or from gathering forensic health information or sharing confidential health information or its interpretation for use in abusive treatment of prisoners. They are also instructed not to authorize or approve any physical punishment of patients and not to assist in the weakening of prisoners’ mental or physical resistance. They are told to ensure that their employer’s policies prevent the abuse of prisoners, provide from the reporting of such abuse by health professionals and protect the professionals who do report abuse. Finally, they are instructed to help eliminate prisoner abuse by implementing appropriate staff training.
One weakness of the report is the frequent use of permissive language (“should”) when mandatory language (“must”) would be more appropriate. Sadly lacking is a call upon such health care professionals to prevent or stop the abuse or torture of prisoners they personally witness. However, it is a good start on addressing a timely subject.
Source: NCCHC Position Paper: Correctional Health Care Professionals’ Response to Inmate Abuse (available at ncchc.org/resources/statements/inmate_abuse.html).
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