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Transfer to Jail
A complete discussion of transfer of care from, and back to, office medical practice requires consideration of the patient who goes to jail, where physicians and other providers must monitor, medicate and attend to medical problems new and old.
Although some visit an emergency department on the way to jail, in most cases routine medical care starts after incarceration, and the office-based physician may not know until notified by the patient’s family member. Ordinarily jail health service staff take over care since the patient can no longer visit the physician’s office. Jail staff must also obtain, store and administer medications.
Much depends on the duration of incarceration. The inmate may not need medical attention at all during a short stay, but an extended stay increases the possibility that the office-based physician may have closed the practice or taken an extended leave with no ability to assist the patient in obtaining care elsewhere. Jail medical staff may have no warning of release of the patient to allow for adequate assessment and referral. An inmate who has been managed adequately on an outpatient basis prior to incarceration may deteriorate and need inpatient care at the time of release. Judges ordering release, and even defense attorneys, may be oblivious to such considerations. By the time of discharge the office physician may be unable or unwilling to continue new treatments instituted by jail staff.
Currently, office-based physicians might face charges of abandonment if they refuse to accept the patient after release. By indiscriminately accepting such patients office-based physicians enable sloppy, inadequate treatment by already overwhelmed jail staff, promote inadequate and unsafe patient care, and gratuitously incur liability. Change will only occur when outpatient physicians take a stand. As with hospital admissions we, and our patients, must demand that jail staff contact us for coordination of orderly transfer of care at the time of incarceration, and for consideration of acceptance for resumption of care after release. Alternatively, jails could implement telemedicine technologies to allow continued care during incarceration. Jail staff should have access to cloud-based digital patient records.
Depending on its duration, and the patient’s condition, incarceration effectively terminates the patient-physician relationship. We must reject the notion that refusal to resume care after release from jail or discharge from hospital constitutes abandonment. It does not. I propose that we instead report jail medical staff and hospital staff to medical disciplinary boards for abandonment if they fail to arrange follow up. I predict the boards, cynical and motivated by politics as usual, will fail to do the right thing. At that point we must expose the boards.