Every prisoner who will be incarcerated for longer than a few hours should be
screened for communicable diseases, including tuberculosis and sexually
transmitted diseases (STDs), because transmission is common in prison
populations. The prison population is predominantly young, single males who
have a high prevalence of venereal infections. These infections should be
identified and treated to protect the health of the infected prisoner and to
prevent the spread of disease in the prison. Prisoners should also be screened
for HIV and hepatitis because of the high infection rates among drug addicts.
Beyond these common diseases, prison physicians should work with local health
authorities to determine which other communicable diseases are prevalent in
their prison population. Ideally, prisoners with inadequate immunization
histories would be immunized against tetanus, measles, and other childhood
diseases. An admission physical should also screen for chronic diseases or
conditions that might cause problems if they remain untreated. Since work will
be part of prison life in most cases, the prison physician should look for any
disabling conditions that might require special consideration. Just as prisoners
are entitled to expect reasonable care for acute problems, they are entitled to
expect that their prison work will not endanger their health.
It is wise for any jail or prison to have comprehensive policies for control of
certain communicable diseases, particularly tuberculosis, hepatitis, and HIV.
Without formal policies, decisions tend to be made in the heat of the moment
on nonmedical grounds. This ad hoc disease control is usually ineffective and
can be expensive. For instance, if there is no policy for immunizing staff
against hepatitis and no determination of who is at risk for contracting
hepatitis, then there is likely to be a large demand for gamma globulin shots
every time a prisoner develops jaundice. In addition to the cost of the shots,
the institution that perpetuates the myth that hepatitis can be spread by
casual contact may find itself paying for every case of community-acquired
hepatitis among its employees as a workers’ compensation claim.
Prison communicable disease policies should be developed in conjunction with
state and local public health authorities. In most instances, the prison physician
is not exempt from the communicable disease control laws of the state,
including reporting laws. Telling the county sheriff that there is tuberculosis in
the jail is not the same as telling the county health officer. As a practical
matter, the prisoner and his or her disease is probably well known to the local
public health clinics. Getting current records can save a lot of time, effort, and
Communicable disease control policies must protect inmates from infection
while not unduly interfering with the rights of the infected prisoners. HIV-
infected prisoners must be identified to ensure that they receive proper
preventive medical care, but there are no disease control justifications for
isolating them unless they pose a risk of sexual assault to other prisoners. In
contrast to HIV, tuberculosis is a severe problem in prisons and demands both
aggressive investigation of outbreaks and the isolation of infectious prisoners.
The federal courts have found that failing to protect prisoners from tuberculosis
violates the requirements of the U.S. Constitution. The National Center for
Prevention Services of the Centers for Disease Control and Prevention has
prepared a monograph “Controlling TB in Correctional Facilities,” which should
be part of every correctional medicine program.