Better procedures needed on care of prisoners in hospitals

Letter: Prisoners in general hospitals: Doctors' attitudes and practice; BMJ Volume 332 pp 548-9

Better procedures and training are needed to improve the care of prisoners in general hospitals, argue doctors in a letter to this week's BMJ.

They surveyed 76 consultants and 139 junior doctors at a hospital near a large prison in Dublin to assess practices towards prisoners.

Guidelines from the BMA recommend examination and treatment without constraints, and without prison officers present, unless the risk of escape is high or the prisoner is a threat to himself or herself, the healthcare team, or others. The new Ethics Guide from the Irish Medical Council is consistent with this, stating that prisoners must be treated with courtesy and respect and afforded confidentiality but with due regard for security.

A total of 184 responded (60% of consultants and all junior doctors). In all, 181 were unaware of any guidelines in place for the treatment of prisoners in general hospitals. Almost all (180) had treated prisoners as patients at some stage in their career, and almost two thirds (111) felt uncomfortable while examining prisoners.

Only six doctors believed that breaches of confidentiality never occurred whereas 13 thought that they always happened and 162 sometimes. Consistent adherence to BMA guidelines was carried out by a minority.

This survey shows that hospital doctors have low awareness of guidelines for due preservation of confidentiality and also report patterns of professional conduct which militate against confidentiality, say the authors.

They suggest that hospital and prison authorities need to develop procedures to allow for reasonable levels of medical confidentiality between prisoners and healthcare staff. They also believe that those who teach ethics and professional conduct need to incorporate routine training on the care of prisoners.

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