September 12, 2018 / 4:41 PM / 10 days ago

Lack of surgical care in U.S. prisons may cost lives

(Reuters Health) - Poor healthcare in America’s prisons may be leading to avoidable deaths, a new study suggests.

Researchers who examined autopsy reports for inmates who died while incarcerated in Florida’s Miami Dade County found that two-thirds of those who needed surgery for a non-liver-related medical condition never got it, according to the report published in JAMA Surgery.

“This was a number that surprised us,” said the study’s lead author Dr. Tanya Zakrison, an acute care surgeon at the Ryder Trauma Center and an associate professor of surgery at the University of Miami. “This raises red flags about the access to surgical care for these patients because no one should die from an entrapped groin hernia.”

Zakrison and her colleagues suspect that their study may have underestimated the number of people who should have gotten surgery but didn’t, because “not all correctional facilities have mandatory autopsy requirements and data collection on mortality is voluntary,” she said.

Moreover, the researchers only looked at cases where a prisoner died. Others may have suffered complications from delayed diagnosis or care, Zakrison said.

Zakrison’s team found that out of the 301 autopsy records provided to them, 18 deaths were due to trauma, such as hanging or traumatic brain injury, and 51 were due to conditions that would require surgery, 30 of which were associated with cirrhosis of the liver.

Focusing on the 21 deaths from conditions not related to cirrhosis, the researchers found that two-thirds occurred in prisoners who never got the surgery that might have saved their lives.

While the new study is small, it uncovers a serious problem, experts said.

“The results are shocking and disturbing,” said Dr. Albert W. Wu, an internist and professor of health policy & management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “Correctional facilities are risky places to start. But this shows patients are also at risk for not getting good healthcare. Just because someone is in prison, doesn’t mean they should die of (conditions like) appendicitis.”

The study also points to “a problem with lack of oversight over quality of care,” said Wu, who was not involved with the new research. “This population is at risk for health problems. And they require better care than it looks like they are getting.”

It’s very likely that these kinds of problems aren’t limited to Miami Dade, said Dr. Joe Hines, a professor and chief of general surgery at the David Geffen School of Medicine. Hines is also a member of the editorial board for JAMA Surgery, but was not involved in the review of Zakrison’s study.

“I would imagine that there is a similar situation across the country,” said Hines. “This is another example of a population in our country that is completely underserved. For those who can access health care and the best doctors, things go pretty well, but that’s not true for most of the country and the prison population is in that same bucket.”

Both Wu and Hines urged a closer look at the problem.

“I don’t think anyone has reported data like this before,” Hines said. “It deserves follow-up, a real nationwide study that uses as much data as possible.”

SOURCE: bit.ly/2x5QQt2 JAMA Surgery, online September 12, 2018.

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