Lessons Learned & Best Practices for Managing Forensic Patients in Healthcare Facilities


“At any given moment there are prisoners in a hospital- sometimes several. The only other public place that can claim these numbers is a courtroom. But, unlike a courtroom, most hospitals lack a uniformed/armed presence, metal detectors and holding cells. When transport officers bring prisoners into a hospital, they are effectually on their own,” (Lashley, 2009).

Although it is no secret that prisoners often receive care in hospital facilities, it is not commonly known by most of the general public. Thus, then when a situation arises involving a prisoner as a hospital patient, often other patients are then worried that their own safety may be at risk. The result of a class action law suit in 1976, Estelle v. Gamble, found that depriving prisoners of necessary medical treatment in correctional facilities was cruel and unusual punishment. This created a great deal of change to correctional facilities as they would all now be required to provide medical care to all incarcerated individuals  in their facility or must provide access to necessary care through transport to a healthcare facility (Kucera, 2011).  The United States then began to recognize that inmates in fact did have rights to proper medical treatment and it is the responsibility of each state to ensure that proper healthcare was readily available if they are to need it.

Prisoners’ receiving medical care outside of their correctional facility is a high risk situation for everyone involved in the process. For that reason, there are many different regulations, laws, and procedures that are necessary to follow when transferring a prisoner-patient to a medical facility. There are several different restraints that can be used to secure prisoner-patients throughout this process including handcuffs, belly chains, leg irons, and black box security devices. The transfer process of prisoners to medical facilities is considered one of the most risky situations that correctional officers and law enforcement officers can engage in (Mikow-Porto and Smith, 2011). Even with all of the protocol necessary to follow by correctional officers and security plus the restraints, there are still an abundance of prisoner escapes from healthcare facilities each year.

In order to minimize risk when a prisoner-patient is in a healthcare facility, healthcare security and correctional officers need to work together. “The healthcare industry needs to recognize the risk presented by the presence of these prisoners as patients, and take appropriate steps to mitigate that risk to the largest degree possible,” (IAHSS, 2013).  Hospital organizations need to make sure that their employees, patients, and any visitors are as safe as possible. To ensure the safety of the hospital and all of the people within it, there needs to be a plan in place for when prisoners are patients in their hospitals.

The media reported a range of cases where prisoners escaped from hospitals throughout 2015. The cases vary greatly. Some of the escapes are planned, some involved weapons, and some were executed with little planning at all. In all cases, it proves that hospital security measures in the case of a prisoner as a patient situation could be improved.

Characteristics of Jail and Prison Populations

With over 2 million people currently in United States’ prisons or jails, the United States has the world’s highest incarceration rate, (Sentencing Project).  Jail incarceration rates did decrease from a peak of 259 per 100,000 in 2007 to 234 per 100,000 at midyear 2014 (Minton, Zeng 2015).  However, even with this decrease, the large number of prisoners in the US remains a significant problem.

In 2011-12, it was estimated that 40% of incarcerated individuals currently had a chronic medical condition (Berzofsky, Maruschak, and Unangst 2015).  According to a special report  released by the Bureau of Justice Statistics in February of 2015 (Medical problems of Jail Inmates, 2011-12), both prisoners and jail inmates were more likely than the general population to report ever having a chronic condition or infectious disease.

Among these incarcerated individuals, chances are some form of a medical situation will come up that will require medical attention that cannot be performed within the correctional facility they are held in. When it comes to medical treatments within a correctional facility, some institutions have chronic care clinics to provide services to patients with diabetes, heart conditions and other chronic conditions (Dept. of Corrections WA State). If it is medically necessary for an inmate to leave the facility for medical treatment they will be transported to a nearby hospital. As reported in a study conducted by the International Healthcare Security and Safety Foundation in 2011 (Mikow-Porto, Smith 2011), there is little scholarly research that has been done looking into the treatment of prisoners, good or bad, while in hospitals.

With no national system for tracking and collecting information on any incidents relating to violence or escapes associating with the medical care of prisoners, that leaves it to the media to find this kind of information (Mikow-Porto, Smith 2011).  The media can often report with biases or they sometimes leave out parts of a story. With that stated, that makes it difficult to know the accuracy of prisoner escapes from hospitals that have only been reported on by the media.  What is reported by the media is all that the general public will then become aware of. Prisoner’s escapes from healthcare facilities pose a high risk of adverse consequences to the facility’s staff, patients, and the general public, all which has been indicated by the media’s reports (Mikow-Porto, Smith 2011).