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Am J Public Health. 2018 Apr;108(4):472-476. doi: 10.2105/AJPH.2017.304248. Epub 2018 Feb 22.

Prison Health Care Governance: Guaranteeing Clinical Independence.

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At the time of writing, Jörg Pont was a consultant on health care in detention Vienna, Austria. Stefan Enggist is with the Swiss Federal Office of Public Health, Bern, Switzerland. Heino Stöver is with the University of Applied Sciences, Faculty of Health and Social Work, Frankfurt am Main, Germany. Brie Williams is with the Division of Geriatrics, University of California, San Francisco. Robert Greifinger is a consultant on health care in detention, New York, NY. Hans Wolff is with the Division of Prison Health, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.


Clinical independence is an essential component of good health care and health care professionalism, particularly in correctional settings (jails, prisons, and other places of detention), where the relationship between patients and caregivers is not based on free choice and where the punitive correctional setting can challenge optimal medical care. Independence for the delivery of health care services is defined by international standards as a critical element for quality health care in correctional settings, yet many correctional facilities do not meet these standards because of a lack of awareness, persisting legal regulations, contradictory terms of employment for health professionals, or current health care governance structures. We present recommendations for the implementation of independent health care in correctional settings.

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