Events

Inpatient and Incarcerated: Ethical Challenges in Caring for the Carceral Population

Moderator: Lauren Berninger DO, MBE

Panelists: Jeffrey Natterman Esq. , Sharon Owens CRNP, Najah Williams MSW, LCSW-C

Case:

Ms. L is a 59-year-old woman with a history of hypertension, type II diabetes, atrial fibrillation and severe peripheral vascular disease who presented to the hospital after vomiting blood and passing out.  Emergent endoscopy revealed several bleeding duodenal ulcers and was complicated by bowel perforation. She was immediately taken to the OR for surgical resection of her damaged bowel.  On post operative day 1, several police officers show up to her room with a warrant for her arrest. She is arrested and an arraignment is set for the following week.  The bedside staff is curious about the circumstances surrounding her arrest and begin conducting internet searches.

While recovering from surgery, the correctional officers at bedside prevent the nurses and therapists from ambulating the patient which is standard of care following surgery.  The patient subsequently develops a large lower extremity DVT and complex abdominal abscess.  The patient has an advance directive naming her son as her healthcare agent in the event she loses decision making capacity. Feeling overwhelmed by the complexity of her situation, she tells the nursing staff to call her son to help her make medical decisions.  Hospital staff members are instructed by the warden not to reach out to the patient’s family for fear of witness tampering.  Some staff members experience moral distress while others ask to be dismissed from the case given the charges they discover on the internet.

Objectives:

• Review the rights of incarcerated patients in the inpatient hospital setting
• Explore ethical issues unique to hospitalized incarcerated patients
• Discuss ethical challenges that may arise when electronic searches are conducted on patients.

Questions:

• How should clinicians respond when the justice system interferes with standard of care for incarcerated patients?
• What are the potential harms to incarcerated patients when staff members conduct electronic searches?
• What risks are associated with the care of incarcerated patients and what legal protections are in place for clinicians involved in their care?
• How should an incarcerated patient’s advance directive be honored in the hospital setting?
• What policies and procedures are in place to help staff navigate caring for incarcerated patients?

References:

Batbold S, Duke JD, Riggan KA, DeMartino ES. Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity. JAMA Intern Med. 2024;184(1):28-35. doi:10.1001/jamainternmed.2023.5794Comer AR. Care of Patients Who Are Incarcerated. AMA J Ethics. 2025;27(4):E277-E282. Published 2025 Apr 1. doi:10.1001/amajethics.2025.277

Larsen E, Drabiak K. Medical decision-making when the patient is a prisoner. Clinical Ethics. 2022;18(2):142-147. doi:10.1177/14777509221133660

Natterman, Jeffrey & Pamela Rayne, The Prisoner in a Private Hospital Setting: What Providers Should Know, 19 J. Health Care L. & Pol’y 119 (2017). Available at: http://digitalcommons.law.umaryland.edu/jhclp/vol19/iss1/5

Watson Z, Brown J, Vyas A, et al. Beyond Bars: Evaluating End-of-Life Care and Surrogate Decision-Making for Hospitalized Incarcerated Persons. J Palliat Med. Published online September 3, 2025. doi:10.1177/10966218251376433