The Social Medicine Portal

Robert Greifinger (Social Pediatrics 1976): Public Health Behind Bars

What does a social medicine doctor do?

Robert Greifinger, an RPSM graduate in Social Pediatrics in 1976, has been extensively involved in examining the prison system from a public health point of view. Last year, he published Public Health Behind Bars: From Prisons to Communities, the title of which suggests his social conception of the problem of prisons and health. He is currently an adjunct Professor at the John Jay College of Criminal Justice. Previously, he was the Chief Medical Officer for the New York State of Correctional Services, which was responsible for the health care of 68,000 inmates.

Public Health Behind Bars: From Prisons to Communities was favorably reviewed in the New England Journal of Medicine in May and in the Journal of Urban Health in April.  It will be reviewed in the July issue of the Journal of Correctional Health Care [14(1) July 2008 pp. 232-235].

The health of prisoners and the impact of mass incarceration on the communities we serve is an area of very interest in the DFSM.

Here is the description of the book from the publisher’s website:

• Prisoner reentry is a topic of current interest in correctional and public health
• Coverage includes both health care and topics in law and public policy
• Contributors are experts from such fields as public health and correctional health

Projecting correctional facility-based health care into the community arena, Public Health Behind Bars: From Prisons to Communities examines the burden of illness in the growing prison population, and analyzes the considerable impact on public health as prisoners are released. More than forty practitioners, researchers, and scholars in correctional health, mental health, law, and public policy make a timely case for correctional health care that is humane for those incarcerated and beneficial to the communities they reenter. These authors offer affirmative recommendations toward that evolutionary step.

Chapter authors identify the most compelling health problems behind bars (including communicable disease, mental illness, addiction, and suicide), pinpoint systemic barriers to care, and explain how correctional medicine can shift from emergency or crisis care to primary care and prevention. In addition, strategies are outlined that link community health resources to correctional facilities so that prisoners can transition to the community without unnecessarily taxing public resources or falling through the cracks. Between the authors’ research findings and practical suggestions, readers will find realistic answers to these and similar questions:

• Can transmission of HIV, tuberculosis, and other communicable diseases be reduced and prevented among prisoners?
• How can correctional facilities treat addiction more effectively?
• What can be done to improve diagnosis and treatment of psychiatric disorders?
• Can correctional care benefit from quality management and performance measurement?
• How can care be coordinated between correctional and community health care providers?
• What are the health risks to communities if action is not taken?

Public Health Behind Bars: From Prisons to Communities is a challenge of immediate interest to readers in correctional health and medicine, public and community health, health care administration and policy, and civil rights.

posted by:Matt Anderson

Homer Venters (RPSM IM 2007) on Immigration Detainee Health Care

What do Social Medicine doctors do?

Dr. Homer Venters, a 2007 RSPM Internal Medicine Graduate, is currently working as an Attending Physician at the Bellevue/NYU Program for Survivors of Torture and is a Public Health Fellow, New York University. During his residency at Montefiore, Dr. Venters worked with Bronx Defenders, a legal aid organization in the Bronx, helping to get people involved in the criminal justice system into primary care. This work resulted in the publication of an article about the tragic case of Scott Ortiz in the Harm Reduction Journal. His work as a resident was awarded the Dan Leight Social Medicine Award.

On June 4 2008, Dr. Venters testified in front of the House Judiciary Committee’s Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law. He discussed problems with the medical care provided to Immigration and Customs Enforcement (ICE) detainees. It is clear to people working in the field that ICE detainees are not accorded the same medical care provided to other US prisoners. Dr. Venters outlined some of the reasons why. Specifically he pointed out that the ICE medical system is designed to care for acute problems; it is not set up for persons with chronic medical issues. To quote from his testimony:

“This institutional aversion to caring for detainees with chronic disease is evidenced in recent detainee deaths. One year ago, a 23 year old transgender woman, Victoria Arellano was detained by ICE. Ms. Arellano had AIDS and was taking a life saving medicine to prevent opportunistic infections that could quickly cause pneumonia and death were she to stop. These medicines are essential for people with AIDS and even a brief interruption risks sickness and death for a patient. Despite reporting her medical history and her medication when detained (and throughout her detention), Ms. Arellano was refused her medicine. Over the following weeks, Ms. Arellano developed a cough and fever, which should have prompted hospitalization and evaluation. Instead, Ms. Arellano was given an inappropriate antibiotic by the detention center medical staff, was still refused her needed medication, and returned to her cell. By the time Ms. Arellano’s cellmates staged a protest to draw attention to her deteriorating condition, she had become very ill and died soon thereafter, comatose and shackled to her bed. Faced with a common chronic disease, ICE medical staff withheld the correct medicines, gave inappropriate medicines and failed to seek more competent care for Ms. Arellano. The care that Ms. Arellano required would be routine in almost any medical clinic or hospital in the United States.”

The full testimony is available at the following link: http://judiciary.house.gov/media/pdfs/Venters080604.pdf

Posted by Matt Anderson