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Position Statements
Licensed Health Care Providers
in Correctional Institutions
Introduction
The National Commission
on Correctional Health Care and the Society of Correctional
Physicians are not-for-profit organizations that work toward the
improvement of health services in the nation’s jails, prisons,
and juvenile detention and confinement facilities. The Society
is an organization of physicians specializing in correctional
medicine. The Commission publishes health services standards and
operates a voluntary accreditation program for institutions that
meet these standards.
Occasionally, an issue arises that is not addressed by the
Commission’s standards or has changed since the standards were
last revised. One such issue is state licensing boards’ issuance
of restricted licenses to medical professionals working in
corrections. Accordingly, the Commission and the Society have
adopted the following position statement that, along with the
published standards, may assist facilities in designing their
own procedures on this matter. Background
State licensing boards are agencies charged with the
responsibility of protecting the health and safety of the public
by ensuring that health practitioners have attained the
appropriate education and abide by ethical and professional
standards of conduct. In addition, each state has a medical
practice act that governs the issuance of licenses and the
practice of medicine within its jurisdiction. When a physician
violates these professional standards or the medical practice
act, a state board is empowered to modify, suspend, or revoke
that physician’s license.
Some medical providers, whether working in a corrections
environment or not, may develop diseases or exhibit behaviors
that make it inappropriate for them to practice their profession
without some sort of supervision. State licensing boards,
therefore, occasionally modify a license for a physician or
other provider in need of professional counseling and
rehabilitation for drug, alcohol, or other impairments.
In addition, some state licensing boards, in an effort to
accommodate selected recent immigrant physicians, have granted
special licenses to these physicians so that they may work in
special institutional settings. These individuals do not meet
the requirements of a fully licensed physician.
Different state boards will refer to these modified licenses by
different names, including “temporary,” “probation,” “stipulated
order or agreement,” “practice restriction,” “institutional,”
“restricted,” “disciplinary,” “provisional,” “limited,” and
“conditional.” This position statement will use the term
“restricted” throughout.
The practice of medicine in a correctional setting is a
discipline that requires knowledge of medicine as well as law
and criminal justice. Working in a correctional facility
provides an excellent opportunity for motivated physicians to
encounter a variety of medical conditions and illnesses, treat
patients, and have a major impact on public health.
One of the challenges faced by physicians and other health
practitioners in corrections is to provide necessary patient
care within a rigorous security environment and in concert with
security personnel. Another challenge is to provide
constitutionally required care within a limited budget. Yet
another challenge is to keep resources in pace with the growing
number of inmates. The best physicians will be particularly
adept at providing and advocating good patient care within an
environment that at times may seem to provide disincentives to
patients and practitioners alike.
When correctional physicians do not advocate appropriate medical
care for their patients, they risk harm to
·
their patients;
·
their employer, in the form
of lawsuits or public outcry;
·
the public, in the form of
health threats or increased cost for patient care upon release;
and
·
the medical profession and
its canon of ethics.
Correctional systems, perhaps in an attempt to save money or
adhere to a security procedure that has not been adapted for
medical care, may create pressures to modify or avoid necessary
patient treatment. Restricted licensed physicians, perhaps due
to their inability to easily find employment elsewhere, may be
susceptible to pressures or excessive supervision placed on
their medical autonomy. To be an effective patient advocate, a
physician must be able to resist pressures and constraints on
independent medical practice.
State medical and dental boards must report to the National
Practitioner Data Bank (NPDB) disciplinary actions related to
professional competence or conduct taken against the licenses of
physicians, providers, or dentists. State medical and dental
boards also must report revisions to adverse licensure actions.
Correctional employers should check a prospective physician’s
credentials by contacting the NPDB and state regulatory
agencies. Position Statement
The National Commission on Correctional Health Care and
the Society of Correctional Physicians advocate that physicians,
nurses, and other licensed health care professionals working in
corrections be fully licensed. Corrections departments should
employ only health care professionals who may freely work in a
community setting.
State licensing boards should not issue licenses that restrict
licensed health care professionals’ employment solely to
correctional environments. NCCHC and SCP believe that such
practice imparts a sense that patients in a correctional
environment are undeserving of qualified care that is
similar to care available in the community. This concept is
anathema to the important medical canons of ethics and
disregards the important public health role correctional health
care can play.
Further, correctional systems should not employ licensed health
care professionals whose licenses are restricted to government
institutions, including corrections. It conveys a substandard
image of correctional health care that can inhibit patients from
seeking necessary care; adversely affects recruitment of other
health professionals; and potentially leads to unwelcome public
reaction when there is a negative patient outcome. The public
specter of inadequacy in the correctional medical system may
erode the system’s ability to attain the resources necessary to
operate the system effectively.
It is important to note that this issue transcends physician
qualification. It also applies to nurses, physician assistants,
psychologists, and dentists. These practitioners should be held
to the community standard for competent health care whether they
provide services to inmates or the nonincarcerated population.
It is inappropriate to build a correctional health care system
on health care practitioners who have licenses limited to
corrections only. Adopted by the National
Commission on Correctional Health Care Board of Directors
November 7, 1999
Revised: October 9, 2005
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