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BMJ. 2006 March 4; 332(7540): 548–549.
PMCID: PMC1388166

Prisoners in general hospitals: doctors' attitudes and practice

Helen Tuite, senior house officer, Katherine Browne, senior house officer, and Desmond O'Neill, associate professor

Editor—Research into professional conduct towards prisoners being assessed and treated in general hospitals, as opposed to prison settings and psychiatric services,1,2 is lacking. This hospital is near a large prison, and we noted that prisoners were frequently assessed while chained to prison officers. Guidelines from the BMA recommend examination and treatment without restraints, and without prison officers present, unless the risk of escape is high or the prisoner is a threat to himself or herself, the heae team, or others.3 Healthcare teams and prison officers should assess together the degree of risk in each case.

We used a questionnaire to assess practices towards prisoners of consu and junior hospital doctors in adult clinical practice in this hospital. Of 76 consultants and 139 junior hospital doctors, 184 responded—60% of consultants and all junior hospital doctors. In all, 181 were unaware of any guidelines in place for the treatment of prisoners in general hospitals. Almost all (180) had treated prisoners as patients at some stage in their career, and 166 had done so in the previous two years. Almost two thirds (111) feomfortable while examining prisoners.

Breaches of confidentially were considered to occur commonly in the management of prisoners who were patients. Only six doctors believed that such breaches never occurred whereas 13 thought that they happened always and 162 sometimes; two were unable to give an estimate. Consistent adherence to BMA guidelines was carried out by a minority (table).

Table 1
Professional practices with patients. Values are numbers (percentages) of doctors

This survey shows that most hospital doctors in a hospital adjacent to a prison are likely to have clinical contact with prisoners. Hospital doctors have a low awareness of guidelines for due preservation of confidentiality and also report patterns of professional conduct which militate against confidentiality.

These findings pose several challenges. Hospitals and prison authorities need to develop procedures to allow for reasonable levels of medical confidentiality between prisoners and heae staff.3

Nationally, medical organisations need to clarify guidelines for preservation of medical confidentiality where they may be in conflict with law or custom. For example, Scottish law on restraint and prison officer attendance is at variance with BMA guidelines.4

Professionals who teach ethics and professional conduct to undergraduates and postgraduates need to incorporate routine training on the care of prisoners, a group with high rates of morbidity and death. This need will become more pronounced with the ageing of our society and the presence of more older prisoners, who show alarmingly high rates of illness5 and for whom hospital based care is likely to become more common.


We thank our colleagues who participated in the survey.

Competing interests: None declared.


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2. Earthrowl M, O'Grady J, Birmingham L. Providing treatment to prisoners with mental disorders: development of a policy. Selective literature review and expert consun exercise. Br J Psychiatry 2003;182: 299-302. [PubMed]
3. British Medical Association. Providing medical care and treatment to people who are detained. (accessed 9 Sep 2005).
4. Boyce SH, Stevenson J, Jamieson IS, Campbell S. Impact of a newly opened prison on an accident and emergency department. Emerg Med J 2003;20: 48-51. [PMC free article] [PubMed]
5. Fazel S, Hope T, O'Donnell I, Piper M, Jacoby R. Hea elderly male prisoners: worse than the general population, worse than younger prisoners. Age Ageing 2001;30: 403-7. [PubMed]

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