Disease Control in Prisons
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 money.
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.