Providing Healthcare in a System of Punishment: How providers experience care work within carceral settings

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 17. The State, Legal System, and Healthcare Policy

Abstract

The US holds the distinction of having the highest incarceration rate in the world while also being the only major industrialized nation that does not provide universal access to healthcare. For many of the most vulnerable in our community, prisons and jails are a primary source of health care. Despite decades of research documenting both the health consequences of incarceration and the poor delivery of health care within prisons and jails, little research has focused on the experience of providing health care within a structurally violent environment. This research is vital as providing health care within carceral settings presents a unique set of challenges for providers. In carceral settings, providers must learn to adapt their medical training for this punitive environment in which they are unable to provide care like they would to patients outside of a carceral facility. We draw on theories of dual loyalty, moral distress, and punishment to explore the provision of health care in prisons and jails based on interviews with 20 health care providers who worked in carceral facilities in California. We describe both experiences of care delivery and how providers sought to engage in or disrupt the system of care they encountered. We propose a framework to delineate how the carceral barriers to health care—carceral culture, institutional control, structural limitations—shape providers’ delivery of care. The proposed framework also outlines the ways that providers respond to these barriers, as some come to terms with the role of their care work within the criminal legal system.

Authors

• Natalie Keller, University of California San Francisco

• Jennifer Elyse James, University of California, San Francisco