A Call to Expand the Patient Bill of Rights Health Justice for Incarcerated Minnesotans

A Call to Expand the Patient Bill of Rights:

Health Justice for Incarcerated Minnesotans

In Minnesota, patients seeking care are protected by the Health Care Bill of Rights. This protection applies to all people receiving care in clinics, hospitals, birthing or surgical centers, nursing homes, chemical dependency treatment facilities, and mental health treatment programs. It does not, however, guarantee the same protections to people who are incarcerated in Minnesota jails and prisons. During the past decades, the number of people incarcerated in Minnesota has increased, as have the health needs of this population. Based on national and local estimates, more than half of incarcerated people have serious mental illness. Increasing numbers also have substance use disorder and chronic medical illnesses. In some jails, the majority of detainees take at least one daily medication. Minnesota jails have thus become de-facto mental health and substance use disorder treatment facilities and also are responsible for managing both the acute and chronic illnesses of the people they house. Despite growing medical complexity among incarcerated people, there is no mechanism for ensuring that these patients receive adequate medical care. Given the often high medical acuity of these patients, we believe that incarcerated people should be included in the protections afforded by the Minnesota Health Care Bill of Rights. In Minnesota, the type of health care a justice-involved individual receives depends on where they are incarcerated. The MN Department of Corrections (DOC) has direct oversight over the operations at

By Hannah Lichtsinn, MD and Calla Brown, MD, MHR

Hannah Lichtsinn, MD

Minnesota state prisons, and this extends to responsibility for health care. The DOC has nurses and advanced practice providers on staff and further contracts with a private healthcare group for physician services. The DOC, however, does not oversee the healthcare offerings at county jails. Minnesota county jails currently house over eight thousand people at any given time. These jails range in size from three to 839 beds. Length of stay can range from days to years. Five Minnesota county jails further contract directly with Immigration and Customs Enforcement (ICE) and detain people held on immigration charges. Each county runs its jail independently, with the sheriff at the helm. There are minimal health guidelines they are required to follow. While they must ensure that incarcerated people have access to health care, there are no details about how this care is to be provided. As a result, the nature and quality of care varies from county to county and jail to jail. Furthermore, because jails are regulated and operated locally, even the DOC does not have the authority to intervene

Calla Brown, MD, MHR

if there are concerns over the quality of care. When an incarcerated person has a concern about the quality of their health care or has experienced a medication error, the current practice is to refer them to the Minnesota Board of Medical Practice, which as an organization is not designed to oversee quality of care. There is currently no incentive or requirement for healthcare providers in MN incarceral settings to provide high quality care. In fact, the largest incentive is to provide low cost care. People who are incarcerated lose access to state funded health insurance including Medicaid. Therefore, the total cost of caring for patients in MN jails falls to the county. This includes reimbursement for nursing and provider time, as well as the cost of any medications provided. As the rates of chronic medical and mental illness as well as substance use disorder within the incarcerated population increase, so does the cost of care, increasing the cost burden for the county as a whole. To combat this, many counties have contracted with private correctional health companies that

promise low costs. Unfortunately this has repeatedly led to cut corners and poorer quality care. For example, the Kandiyohi county jail contracts with a private correctional health company called MeND, which is currently under investigation for violations of medical ethics. During the fall of 2020, there was a widespread outbreak of COVID-19 at the Kandiyohi county jail with nearly three full units, housing both criminal and people detained by ICE, testing positive. According to those detained and an evaluation by ICE, the care in the facility was substandard with reports of lack of basic monitoring including pulse oximetry for COVID positive patients and known placement of COVID positive individuals in a cell with someone who was COVID negative. Further descriptions included that when reporting symptoms, instead of getting a thorough medical evaluation, they were placed into isolation units akin to solitary confinement which is generally used as a form of punishment. On their own assessment of the health care in the facility, the ICE office of Detention Oversight identified numerous compliance violations placing detained people at risk. They found that detention officers without medical training were completing the facility’s medical, dental, and mental health screenings. They also noted that despite having phone interpreter services available, interpreters were not used during medical evaluations of individuals with limited English proficiency. They even discovered cases of individuals being given medical care or even psychotropic medications without consent. Despite these and other failures, ICE took no corrective actions and no MN government agencies have the authority to address the widespread use of substandard medical care. If we were to include incarcerated populations in the MN Health Care Bill of Rights, we would create a mechanism for oversight and accountability. This would allow for regular assessments of the quality of care provided to these patients, ensure jail health services meet community standards of care including for screening and

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treatment of acute and chronic illness, and adequate health professional staffing levels to ensure safety. Our current medical-legal system allows for no accountability and this must change. Recognizing that prison abolition would be ideal for improving population health in Minnesota, we must also ensure that all patients in Minnesota, including justice involved patients, receive high quality medical care.

Hannah Lichtsinn, MD, Internal Medicine and Sickle Cell, Hennepin Healthcare, Assistant Professor of Medicine, University of Minnesota. She can be reached at: shact003@umn.edu.

Calla Brown, MD, MHR, Internal Medicine and Pediatrics, Community University Health Care Center, Assistant Professor of Pediatrics, University of Minnesota. She can be reached at: brow3601@umn.edu.

References: • health care bill of rights: https://www.revisor. mn.gov/statutes/cite/144.651. • https://www.health.state.mn.us/facilities/ regulation/billofrights/docs/mn_pts_rights_ eng_reg.pdf.

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