Over the last 30 years, the role of prison physicians has changed dramatically. Being the doctor for the county jail used to be a relatively easy job. The position was frequently filled by a physician who had retired from private practice. Prisoners were viewed as having little right to medical care, and there was not much concern about its quality. Even incompetent physicians were usually immune from suits for medical malpractice because, as governmental employees, they enjoyed immunity for many of their actions.

Prisons are now highly regulated. (This section will use prison as a generic term for all correctional and detention facilities.) State and federal court cases, combined with legislation, set minimum standards for medical care in prisons and jails. The first effect of these standards was to end most medical experiments on prisoners. In addition, the standards ensure that inmates receive adequate medical care and make it easier to sue physicians and others involved in improperly run prison medical programs. Despite these regulations, prison conditions are deteriorating in many parts of the country. Prisons are overcrowded, and inmates are increasingly HIV infected secondary to the drug abuse that may have led to their incarceration.