By EWA MATUSZEWSKI
One of the most interesting aspects of writing a healthcare column is that the topics can be wide-ranging because the issues surrounding physical and behavioral health and the community of care providers are so vast and far reaching. That being said, I believe I am introducing a topic today that is rarely discussed: What are we to do with incarcerated physicians who happen to be qualified clinicians? For physicians who have not committed capital crimes or crimes related to physical, sexual and emotional abuse, should we be considering the establishment of guidelines and programs for acceptable use of their medical skills behind bars?
Over the course of my career in the physician organization field, I have personally known about five physicians who have been imprisoned – all for crimes related to wrongful prescribing/overprescribing prescription drugs in the pre-opioid focused era or billing/coding abuse. Illegal activity? Character flaw? Abhorrent behavior? Yes, on all three counts; but does that mean their actual clinical skills as a physician, which in all cases were not in question, must be wasted as they serve their time?
Michigan’s prison system shortage of healthcare providers in nearly all categories is well-documented; are we overlooking a potential solution to mitigate the physician shortage component of the prison system’s inadequate healthcare? If that causes you pause, look at the issue from an administrative standpoint. Prisoners’ medical records are still tracked on paper and not through an EHR. Could a cohort of qualified, imprisoned physicians in supervised settings make inroads on transferring the paper trail to useable health data that prisoners could access when they become returning citizens?
Of course, there may be incarcerated physicians who do not want to take on an administrative role or practice medicine within their own prison walls. So be it, as any type of program would need to be completely voluntary. At the same time, non-physician inmates would have the right to refuse any type of healthcare provided by a fellow inmate, physician status notwithstanding. One of the few successful bi-partisan efforts in recent years involves the early release of non-violent offenders. Does that open the door for other innovative solutions within our prison system?
After writing the first draft of this column, I did two things: 1) re-read a letter written by an imprisoned physician and recently shared among my friends and 2) a Google search on incarcerated physicians, which netted only stories (and typically older stories) about physicians who serve the prison population. Let me share (with permission) what the physician wrote: “Being assigned to kitchen duty means I wake up at 4:30am to help make 3,000 meals a day served in toss-away trays and then clean up everyone’s trash. By obeying the rules, being respectful, working hard, I am respected in return. There is no education or counseling provided for anyone unless you are on psych meds. I have had to make most of my confinement experience, so I am in the process of earning two degrees in gardening and Biblical Studies. The First Step Act and Elderly Offenders Program should be very useful too, since I may be able to get home confinement.”
Both the physician’s comments and the results of the Google search affirmed my belief that this is a conversation that needs to continue. The AMA and AOA should begin to have a conversation about clinical knowledge being squandered. Let’s think about a federal waiver or a limited federal license provided physicians so they could practice medicine. If change regarding the providing of direct patient care by incarcerated physicians ultimately does not occur, it seems likely the exploratory process would likely result in healthcare transformation in prisons and solutions to other healthcare challenges facing the prison system today.