The surgery went without a hitch. The patient had needed a temporary colostomy to divert his bowel contents to a bag, but now we were able to complete the second stage, closing the ostomy and returning his anatomy to normal. He recovered smoothly in the hospital and like most patients after this procedure, he was ready for discharge in a few days. He still had skin staples in and a healing, open wound, which required follow-up care. And the surgery he had carries risks that we needed to monitor after hospital discharge. But because this patient was incarcerated, that routine care never happened.

Dr. Beard, his surgeon, called the prison multiple times to arrange his follow-up visits, but he was never brought to clinic and disappeared from view. At one point, the prison provider reported that the patient was “fine,” and that they had removed his staples there. But his surgeon, Dr. Beard never had the chance to confirm this, to make sure a patient after major surgery was doing alright, to connect with him, or to answer his questions.

This case is typical. Without clear protocols for providing surgeries to patients in custody, care is often delayed, disrupted, or incomplete before and after surgery, placing major limitations on individuals’ health and recovery. Our team of lawyers and surgeons spelled out the need for better protocols in a recent review article in JAMA Surgery.  

We lack comprehensive information on how many patients in custody need or undergo surgery in the U.S. But available data suggest that while the need for surgical care is common, access is incomplete. The most recent Bureau of Justice Statistics data addressing surgical care is from 2004, and it reports that one in eight incarcerated individuals underwent surgery while in prison, with higher rates among older prisoners.

Incarcerated Patients Face Many Barriers to Care

More concerning, studies indicate substantial unmet need for surgical care. Busko et al. reviewed autopsy data on incarcerated individuals who died in Miami Dade County from 2008-2014 and found that nearly one quarter of deaths were related to trauma or other conditions potentially treatable with surgery, but only one in three of patients with those conditions had actually received surgical care. This is likely at least in part because although prisons are legally required to care for incarcerated people, prison health systems are often overburdened and understaffed, leading to low rates of preventive care and screening.

When patients do make it to the hospital for surgery, their incarcerated status poses many challenges to high-quality, equitable care. It can be difficult to schedule pre- as well as post-operative visits. Incarcerated individuals are often required to be continuously under guard, even in a clinic or hospital bed. The lack of privacy limits a surgeon’s opportunity to build a relationship, collect essential information, and answer a patients’ honest questions.

In the office and in the hospital, incarcerated patients are generally shackled at all times. This physical restriction can impair clinicians’ ability to do a good post-operative physical exam. It also severely limits patients’ mobility. As surgeons, we emphasize every day to our patients how important staying mobile, being out of bed, and walking the halls are to their recovery, not just to keep their arms and legs limber , but to promote intestinal recovery and prevent complications like pneumonia.

It is routine and humane for surgeons to communicate promptly and clearly not only with patients, but with their families and loved ones around the time of a major procedure. The families often do not have this right, and have limited or no ability to visit their loved one in the hospital. All these factors can harm patients’ physical and mental well-being in the unique and frightening setting of surgical care.

As trauma and emergency surgeons, we also care for patients with serious injuries or surgical emergencies. While these patients are generally not formally incarcerated (after being convicted of a crime), they may be under arrest (in police custody, but not yet been formally charged) or may come into contact with police during their emergency care. While police may have urgent or nonurgent investigative goals when a patient is injured, their presence and questions can disrupt care, impede privacy, compromise patients’ legal rights, and promote fear and distress in patients going through a traumatic event. Patients under arrest are often shackled and guarded as well, and may have even fewer rights and less mobility than those who are incarcerated. Clinicians may also have even less clarity as to what is allowed when caring for them.

What’s Needed to Improve the Prison Health System 

Our team of surgeons and lawyers from Florida, Georgia, New York, Washington, Connecticut and Pennsylvania recently reviewed the data and policy involving the care of surgical patients. To ensure access to equitable, high-quality surgical care for patients in law enforcement custody, we recommend the following measures:

• For individual surgeons and other clinicians: Understand the various categories of law enforcement custody and the risks they pose to patient care, and advocate for maximum continuity of care and patient privacy, mobility, and protection.
• For health systems and medical organizations: Establish partnerships and clear pathways for care between prison health and external providers. Advocate for enhanced mobility after surgery and for continuity of care.
• For public health: Data collection on health in jails and prisons should include surgical needs, and surgical databases should include information on custody status.
• For policymakers: Mass incarceration poses numerous health hazards that affect not only incarcerated persons but their families, communities and the health system. While enhancing prison healthcare can ease some of these ills, ultimately prison is not a healthy environment and reducing our tragically high incarceration rates is essential.

Research on surgical care and health in general for incarcerated patients is limited. While ethical restrictions in place to prevent coercion in research are essential, these can limit our ability to hear the voices of incarcerated people. Research should assess the health and surgical needs of incarcerated people but also seek to understand their perspectives and priorities, on what, where, and how they want to receive this care.

Dr. Elinore Kaufman is a Senior Fellow of the Leonard Davis Institute of Health Economics. She is an Assistant Professor of Surgery and Director of Research in the Division of Trauma, Surgical Critical Care, and Emergency Surgery at the University of Pennsylvania where she also serves as Medical Director for the Penn Trauma Violence Recovery Program, a hospital-based violence intervention program. Dr. Jessica H. Beard is Associate Professor of Surgery and Director of Trauma Research at Temple University Lewis Katz School of Medicine and Interim Trauma Program Medical Director at Temple University Hospital.

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The article, “Providing Equitable Surgical Care to Patients in Law Enforcement Custody: A Review,” was published in JAMA Surgery on May 14, 2025. Authors include Elinore J. Kaufman, Jesse E. Passman, Rucha Alur, Randi Smith, Anwar Osborn, Sara Scarlet, Kimberly Sue, Robert Wright, Rebecca Maine, Nephetari Smith, Nia Holston, Emily Zhu, and Jessica H. Beard.

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