Standards of Care for Assaulted Patients in Custody

Abstract: Patients who are incarcerated routinely experience physical and sexual violence, yet clinicians are often limited in their ability to address structural factors and ensure safety after discharge. This article explores the ethical and clinical challenges physicians face in treating incarcerated individuals, particularly dual loyalty conflicts between patient advocacy and institutional pressures. We argue that incarcerated patients should receive the standard of care afforded to other vulnerable populations, and that clinicians and health systems must embrace a broader role in violence prevention even during incarceration. This approach will require interventions at the individual, institutional, and policy levels. Potential solutions include care coordination and discharge planning with local correctional facilities, the creation of ICD codes to track in-custody assaults, and advocacy including medico-legal partnerships. Addressing this neglected public health issue is important to advance equity and improve the health and safety of patients who are incarcerated.