Health care and Justice

When should health professionals bridge the gap between providing health care and justice to an offender.

On one of my clinical blocks I was given a 21-year-old patient who sustained a gunshot wound to his abdomen. He was under police custody at the time and from the subjective interview I conducted, I found that he was shot by the police because he got caught trying to hijack a car. This patient was an offender and was due to stand trial immediately after being discharged from the hospital. On the day I was given this patient I found that all the doctors were ready to have him discharged and were waiting for me to assess and give them the go ahead to release the patient. The police had also prepared a document for him to also be released on that very same day. My duty was to see if the patient was able to walk independently so he could stand trial.  Therefore, I went on to assess the patient with my supervisor and found that the patient’s gait was abnormal, he had poor muscle power in one of his lower limbs, decreased sensation and could not dorsiflex and plantarflex his foot. His dynamic balance was poor and thus he was very unstable. He needed assistance in moving from sitting to standing and with mobilization.

After assessing the patient, I concluded that the patient was not ready to be discharged so I made the doctors, as well as the sister in charge aware of the patient’s condition. When informing the sister in charge about my findings, she did not approve of the fact that the patient needed to stay longer. She mentioned that there was no space for him and that he had to leave that very same day. The sister in charge and one of the other nurses also made a comment about how this patient would ultimately end up in prison any way and that, he would not need devices such as an AFO or crutches in the prison cell. She also said that this patient could stay in the ward for the next three weeks waiting for an AFO which he would probably not need. The policeman who was there also made a comment about how the patient could potentially be pretending to have those symptoms, he also questioned how accurate my assessment was. I was taken aback by this as it made me wonder why this policeman would question my skills. I determined that he perhaps questioned my skills because I am still a student. However, this couldn’t have been the reason because during the assessment session I was being supervised by a qualified physiotherapist who has been practicing for over 10 years. Consequently, I responded to this by reassuring the policeman that my findings were accurate and that I was willing to help this patient.  With that being said, the final decision was made and it was said that the patient would be discharged as he was high risk, meaning he had the potential to run away and so the police were trying to avoid that.

Therefore, the situation above made me wonder when do we as health professionals draw the line between providing health care to offenders and taking justice into consideration. When I spoke to the patient that day, I did not view him as a criminal but rather as a human being who needed my help. So, when informing the sister about what I found, I was surprised by the way she handled the situation which left me clueless as to how I would go about treating the patient within a day and, how effective I would be in doing so. The comments she had made about the patient made me realize that she and the staff members I had spoken to were not willing to assist this patient any further, probably due to the fact that he was an offender. In an ideal world, it is said that human beings have the right to health care but what happens when that very same human being breaks the law. Should they be treated differently when it pertains to health care; should they be given less attention because they broke the law? These were some of the questions that came to mind after analyzing the whole situation. At the end of the day that offender is human and he had a right to be provided with health care services. Also, he needed to be fit to stand trial. However, the circumstances the patient was under were certainly not in my favour. Thus, the decision to have him discharged was made regardless of his physical state.

There are laws put in place to ensure that prisoners or detainees are provided with adequate health care by the prison officials as well as the health professionals who interact with the detained. Under the Bill of Rights, all prisoners or detainees have the right to adequate health care/ medical treatment. Health professionals around the globe are required to provide these services by taking into consideration the ethics of medical care and it’s non-judgmental administration (Shalit & Lawin, 2004). However, it has been found that the provision of health care to prisoners is hardly equal to that provided to the law-abiding citizens. This is likely because of social- economic issues such as: security, medical-legal, and financial issues. These socio- economic issues become limiting factors as they prevent the prisoner / detainee to receive adequate medical care. In addition, it has also been found that there is an ethical conflict in the way prisoners are being treated. An article by Dubler (2014) highlights that ‘the mission of medical care is to diagnose, comfort, and cure whereas, the goal of a prison or jail is to confine, punish, and, almost accidentally these days, rehabilitate.’ The health care staff is usually trained to be sympathetic and supportive towards the detainees but these factors are usually altered over time because of the clashes with the way in which the correctional service operates. Therefore, the conflict between medical sectors and prisons make it a challenge to bridge the gap between health care and justice.

References

Dubler. N, (2014). ‘Ethical Dilemmas in Prison And Jail Health Care’ Health affairs. Received May, 2019 from https://www.healthaffairs.org/do/10.1377/hblog20140310.037605/full/

Shalit. M & Lewin. M.R (2004). ‘Medical care of prisoners in the USA’ Medicine, Crime, and Punishment. Vol 364. Received May, 2019 from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673604176332.pdf