Why It Is Important to Promote Clinical Independence Among Health Professionals Working in Prisons, Jails, and Other Detention Settings

[...]standards unanimously adopted by the United Nations General Assembly in December 2015-the "Mandela Rules"- assert that "Prisoners should enjoy the same standards of health care that are available in the community.. ,"1(Rule 24) What courts and international guidance documents have not been able to do is explain in much detail what quality ofmedical care is required. Health professionals are both uniquely situated and specially trained to detect prisoner abuse, and the World Medical Association calls doctors "privileged witnesses" with regard to torture (http://bit. ly/2CNNejt). [...]US prisoners are at least 17 times more likely than the general population to be infected with HCV4; they are 12 times more likely to report ever having tuberculosis and more than three times as likely to report having HIV/AIDS.5 Meanwhile, mental illness is rampant in all types of detention facilities, typically affecting well over half of all detainees.6 Because trust is especially critical to the detection and management of stigmatized illnesses such as those just mentioned, the development ofan effective patient-clinician relationship is of particular value to prisoners suffering from these conditions, and hence it is also ofvalue to local communities, into which more than 90% of prisoners will eventually be released.7 CLINICAL INDEPENDENCE IS UNDER SIEGE In the end, Pont et al., along with most readers of this journal and undoubtedly many others, already agree that it is critical to protect and promote clinical independence in detention settings.