Correctional healthcare, like care in the community, involves a patient and a doctor who meet in an examination room. The patient voices his or her complaints, the doctor takes a history and then performs a physical examination. Perhaps some testing is needed. There is then a diagnosis and a recommended treatment. Straightforward, right?
Not quite.
Healthcare, in reality, is not simple and straightforward. In fact, a considerable amount of work is spent outside the exam room and involves more than just the doctor. Healthcare in the correctional setting is perhaps even more complex because of the additional factor of safety and security – and the involvement of correctional officers who frequently are not health-focused.
So, who is responsible for coordinating this healthcare “web” of interconnected systems and moving parts? The National Commission on Correctional Healthcare uses the term “Responsible Health Authority” as the individual, corporation or government entity that ensures “the organization and delivery of healthcare” within prisons and jails. Therefore, when it comes to the delivery of care in a prison or jail setting, the Responsible Health Authority is as involved as the doctor and the patient.
A useful paradigm for correctional healthcare comes from the field of public health and is known as the epidemiological triangle. The triangle models how clinical conditions such as diseases and injuries come to be.
The epidemiological triangle theory says that all points of the triangle have to be present and interact in the right way for a particular condition to develop.
- There first has to be a susceptible host, which refers to the incarcerated individual.
- There also needs to be an agent, which is the causative factor for whatever disease or injury is under consideration. Some examples of “agents” include infectious organisms, weapons, cancer, or atherosclerotic plaque.
- Lastly, since nothing happens in a vacuum, a disease-amenable environment must also be present.
The strength – or weakness – of the Responsible Health Authority affects this last leg of the epidemiology triangle. Without a strong organization, sound policies, and a commitment to patient safety and continuous quality improvement from the Responsible Health Authority, adverse health-related outcomes will continue to affect the incarcerated population.