Licensed Health Care Providers in Correctional Institutions
The National Commission on Correctional Health Care and the Society of Correctional Physicians are not-for-profit organizations that work toward the improvement of health services in the nation’s jails, prisons, and juvenile detention and confinement facilities. The Society is an organization of physicians specializing in correctional medicine. The Commission publishes health services standards and operates a voluntary accreditation program for institutions that meet these standards.
Occasionally, an issue arises that is not addressed by the Commission’s standards or has changed since the standards were last revised. One such issue is state licensing boards’ issuance of restricted licenses to medical professionals working in corrections. Accordingly, the Commission and the Society have adopted the following position statement that, along with the published standards, may assist facilities in designing their own procedures on this matter.
State licensing boards are agencies charged with the responsibility of protecting the health and safety of the public by ensuring that health practitioners have attained the appropriate education and abide by ethical and professional standards of conduct. In addition, each state has a medical practice act that governs the issuance of licenses and the practice of medicine within its jurisdiction. When a physician violates these professional standards or the medical practice act, a state board is empowered to modify, suspend, or revoke that physician’s license.
Some medical providers, whether working in a corrections environment or not, may develop diseases or exhibit behaviors that make it inappropriate for them to practice their profession without some sort of supervision. State licensing boards, therefore, occasionally modify a license for a physician or other provider in need of professional counseling and rehabilitation for drug, alcohol, or other impairments.
In addition, some state licensing boards, in an effort to accommodate selected recent immigrant physicians, have granted special licenses to these physicians so that they may work in special institutional settings. These individuals do not meet the requirements of a fully licensed physician.
Different state boards will refer to these modified licenses by different names, including “temporary,” “probation,” “stipulated order or agreement,” “practice restriction,” “institutional,” “restricted,” “disciplinary,” “provisional,” “limited,” and “conditional.” This position statement will use the term “restricted” throughout.
The practice of medicine in a correctional setting is a discipline that requires knowledge of medicine as well as law and criminal justice. Working in a correctional facility provides an excellent opportunity for motivated physicians to encounter a variety of medical conditions and illnesses, treat patients, and have a major impact on public health.
One of the challenges faced by physicians and other health practitioners in corrections is to provide necessary patient care within a rigorous security environment and in concert with security personnel. Another challenge is to provide constitutionally required care within a limited budget. Yet another challenge is to keep resources in pace with the growing number of inmates. The best physicians will be particularly adept at providing and advocating good patient care within an environment that at times may seem to provide disincentives to patients and practitioners alike.
When correctional physicians do not advocate appropriate medical care for their patients, they risk harm to
• Their patients
• Their employer, in the form of lawsuits or public outcry
• The public, in the form of health threats or increased cost for patient care upon release
• The medical profession and its canon of ethics
Correctional systems, perhaps in an attempt to save money or adhere to a security procedure that has not been adapted for medical care, may create pressures to modify or avoid necessary patient treatment. Restricted licensed physicians, perhaps due to their inability to easily find employment elsewhere, may be susceptible to pressures or excessive supervision placed on their medical autonomy. To be an effective patient advocate, a physician must be able to resist pressures and constraints on independent medical practice.
State medical and dental boards must report to the National Practitioner Data Bank (NPDB) disciplinary actions related to professional competence or conduct taken against the licenses of physicians, providers, or dentists. State medical and dental boards also must report revisions to adverse licensure actions. Correctional employers should check a prospective physician’s credentials by contacting the NPDB and state regulatory agencies.
The National Commission on Correctional Health Care and the Society of Correctional Physicians advocate that physicians, nurses, and other licensed health care professionals working in corrections be fully licensed. Corrections departments should employ only health care professionals who may freely work in a community setting.
State licensing boards should not issue licenses that restrict licensed health care professionals’ employment solely to correctional environments. NCCHC and SCP believe that such practice imparts a sense that patients in a correctional environment are undeserving of qualified care that is similar to care available in the community. This concept is anathema to the important medical canons of ethics and disregards the important public health role correctional health care can play.
Further, correctional systems should not employ licensed health care professionals whose licenses are restricted to government institutions, including corrections. It conveys a substandard image of correctional health care that can inhibit patients from seeking necessary care; adversely affects recruitment of other health professionals; and potentially leads to unwelcome public reaction when there is a negative patient outcome. The public specter of inadequacy in the correctional medical system may erode the system’s ability to attain the resources necessary to operate the system effectively.
It is important to note that this issue transcends physician qualification. It also applies to nurses, physician assistants, psychologists, and dentists. These practitioners should be held to the community standard for competent health care whether they provide services to inmates or the nonincarcerated population. It is inappropriate to build a correctional health care system on health care practitioners who have licenses limited to corrections only.
Adopted by the National Commission on Correctional Health Care Board of Directors
November 7, 1999
Revised: October 9, 2005
Latest review and reaffirmation: October 2012