Health care problems in prisons.

© 2000 Canadian Medical Association or its licensors The principle that prisoners are entitled to the same level of health care as that provided in the wider community is accepted in enlightened society and within enlightened prison systems. Ruth Elwood Martin (page 637) documented the number of female inmates at a BC institution who would be willing to undergo Papanicolaou smear screening if the test was offered. Her results raise a disturbing issue with respect to the population that she studied, one that has wider implications for prison health care at both provincial and federal institutions. Martin found that 75 of the 100 women who responded to her survey at the time of their entry to the Burnaby Correctional Centre for Women (BCCW) (in February and March 1998) would accept Pap smear screening for cervical neoplasia if it was offered. However, a 1995 study at the same institution found that only 15% of inmates actually received such screening while incarcerated. Martin’s data indicate that most prisoners at BCCW have been convicted of drug-related crimes; she points out that female inmates are at greater risk for cervical dysplasia than the general population and, furthermore, that chaotic lifestyles and drug use outside prison usually result in limited contact with the health care system. Thus, a period of incarceration may be the only opportunity for these women to benefit from screening and treatment programs. Martin’s study suggests that the level of medical care in prisons, at least in this instance, is failing to meet community standards. Screening for disease and provision of adequate treatment programs in short-term detention facilities (i.e., provincial jails), which have high turnover rates, is difficult although possible, if these programs are integrated with community services. Because periods of stay are longer in Health care problems in prisons