Healthcare in a system of punishment: how clinicians experience care work within carceral settings

The harms experienced by individuals incarcerated in prisons and jails have been well-documented; however, little is known about the experience of healthcare clinicians in their work in carceral institutions. Using qualitative methods, we interviewed 20 clinicians who deliver care in California’s prisons and jails to better understand their experiences. Participants described a carceral culture which impeded the delivery of care. These barriers to providing healthcare included limiting the clinicians’ ability to develop a trusting patient-clinician relationship and structural limitations which prevented clinicians’ capability to deliver care informed by their expertise. Participants also described forms of institutional control that affected clinicians on a personal level and in their provision of care. We found that clinicians often attempted to advocate on behalf of their patients; however, clinicians struggled to balance their dual loyalties to patients and the carceral system. This often led them to experience moral distress which ultimately led to burnout. These experiences resulted in clinicians developing self-protection strategies by accepting parts of the system, leaving the system, or continuing to try to change the system. The barriers to providing healthcare described by participants are inherent components of prisons and jails, which the clinicians had to adapt to in order to treat their patients. Findings from this study demonstrate the system-wide impacts of the punitive nature of carceral institutions which can even permeate the delivery of healthcare. These findings emphasize the need for additional research examining the impact of carceral culture on clinicians and the care they deliver in carceral facilities.