HMGT 495 University of Maryland Global Wk 3 Correctional Health Care Case Study

You applied and were accepted in an internship program of a state-level, Female Correctional Health Care Operation in the Southeastern United States and your primary responsibility is to work on the assigned projects related to the provision of inmate health care.

Case Study Associated Materials

***Correctional Health Care Delivery: Unimpeded Access to Care Section 2 and 4 are recommended for the main reference in working on this assignment. 

Public Health Behind Bars

Sample Tool Control Policy

Inmate Sick Call Procedures-Corrections

Case Study Details: For the incarcerated population in the United States, health care is a constitutionally guaranteed right under the provisions of the eight amendments which is the prohibition against cruel and unusual punishment (see Estelle v. Gamble). This particular prison can hold in excess of 1,728 offenders and routinely houses between 1,600 and 1,700 women on any given day. This institution incarcerates all custody classes to include minimum security, medium security, close custody, death row, and pretrial detainees. 

The health care operation provides the highest level of care for female offenders in the state. The health care facility is a 101 thousand square foot, 150 bed, three-story building that cost the taxpayers $50 million dollars to construct and is a hybrid of an ambulatory care center, long-term care center, and behavioral care center. The health care facility also houses an assisted living dorm.

The patient demographic includes women who have multiple co-morbidities including substance abuse, seriously persistent mental illnesses (SPMI), diabetes, cardiovascular disease, cancer, morbid obesity, HIV / AIDs, hepatitis, etc. On any given day there will also be 30 to 60 offenders who are pregnant, with 98% of those offenders having a history of substance abuse; all pregnant offenders are considered high-risk. The dental health of this patient population is exceptionally horrendous because of excessive drug abuse coupled with a sugary diet and poor oral hygiene practices. It is not uncommon for a 23-year-old to need all of her teeth extracted.

There are approximately 300 FTEs, including correctional staff, that operate the facility and provide care to the offender population. The healthcare facility is comprised of the following directorates: (a) Medical, (b) Nursing, (c) Behavioral Health, (d) Pharmacy, (e) Dental, (f) Medical Records, (g) Health Service Support, and (h) Operations and Security.

Although the health care facility has a vast amount of capability, there are limitations: (a) This facility does not have advanced cardiac life support capability (ACLS), (b) no surgical capability, (c) no ability to conduct telemetry, (d) no oral surgery beyond simple extractions, (e) no obstetrical capability beyond out-patient clinics, (f) MRI, (g) level 2 ultrasound, and the list goes on.

Those inmates with medical needs that cannot be addressed by the health services staff at the correctional facility will need appointments with external health care providers who have a business relationship with the prisons in this area. On any given month, there will be approximately 300 offenders who will go to outside medical appointments, and making certain that these appointments take place is where the challenge lies. Similar to many healthcare operations, the prison Utilization Review / Case Management Department facilitates all external appointments and forms the lynchpin between the correctional facility healthcare providers who refer offenders for specialty appointments and the outside organization providing that appointment.  

Your assignment: You are the Case Coordinator. You have 300 patients that need to be scheduled for outside specialty appointments every month. You are tasked by the Administrator to develop a strategic plan for organizing the out-of-the-facility appointments without impairing internal services.

***Note: additional personal or financial resources are not available fortis case strategic plan. However, the question of the additional personnel or resources can be discussed in an Addendum. Specific justification must be presented and supported by evidence. 

As the first step, develop a 500-800 word Memorandum addressing:

Provide an overview of Estelle v. Gamble and how that 1976 Supreme Court ruling pertains to the provision of inmate health care.

Examine the challenges of providing health care in a correctional environment.

What are the challenges of providing health care to a female offender population that may not exist in a male prison?

What framework would you apply to strategic planning? Why? (Strategic planning frameworks) 


How to solve

HMGT 495 University of Maryland Global Wk 3 Correctional Health Care Case Study

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In this memorandum, we will address four key questions related to the provision of inmate healthcare within a correctional environment. Specifically, we will discuss the implications of the Estelle v. Gamble Supreme Court ruling on inmate healthcare, identify the challenges of providing healthcare in a correctional setting, explore the unique challenges involved in caring for a female offender population, and propose a strategic planning framework to guide the organization of out-of-facility specialty appointments.


1. Provide an overview of Estelle v. Gamble and how that 1976 Supreme Court ruling pertains to the provision of inmate health care.

Estelle v. Gamble (1976) was a landmark Supreme Court case that established the constitutional right to receive adequate medical care for inmates. The ruling stated that “deliberate indifference to serious medical needs” constitutes cruel and unusual punishment, which is prohibited under the Eighth Amendment. This means that correctional facilities are legally obligated to provide inmates with healthcare that meets acceptable medical standards. It places a responsibility on prison authorities to ensure that inmates have access to necessary medical care, regardless of the limitations or challenges of the correctional environment.

2. Examine the challenges of providing health care in a correctional environment.

Providing healthcare in a correctional environment poses unique challenges due to the nature of the inmate population and the limitations of the correctional facilities. Some of these challenges include:

a. Security concerns: Correctional facilities must prioritize safety and security, which can impact the delivery of healthcare services. Balancing the need for security with the provision of adequate healthcare can be challenging.

b. Lack of resources: Many correctional facilities face resource limitations, including limited budgets, staffing shortages, and outdated or inadequate medical equipment and infrastructure. These constraints can hinder the delivery of quality healthcare to inmates.

c. High prevalence of chronic illnesses: Inmate populations often experience a higher prevalence of chronic illnesses, mental health disorders, and substance abuse issues compared to the general population. Treating and managing these complex conditions within the correctional environment can be challenging, requiring specialized care and coordination with external healthcare providers.

d. Continuity of care: Inmates are frequently transferred between facilities or released back into the community, making it challenging to maintain continuity of care. Ensuring seamless transitions and access to necessary healthcare services during and after incarceration is a crucial challenge.

3. What are the challenges of providing health care to a female offender population that may not exist in a male prison?

Caring for a female offender population presents unique challenges compared to male prisons. Some key challenges specific to female offenders include:

a. Reproductive health needs: Female offenders have specific reproductive health needs, including prenatal and postnatal care, family planning services, and gynecological care. Providing comprehensive reproductive healthcare within the correctional environment can be complex and require specialized resources and staff.

b. Gender-specific healthcare: Women have different healthcare needs and often require gender-specific services related to breast health, menopause management, and sexual assault recovery. Correctional facilities must ensure that these gender-specific healthcare needs are addressed appropriately.

c. Trauma-informed care: Many female offenders have a history of trauma, abuse, or mental health issues. Providing trauma-informed care that acknowledges and addresses these unique experiences is crucial but can be challenging within the correctional setting.

4. What framework would you apply to strategic planning? Why?

The framework that we would apply to strategic planning in this case is the Hoshin Kanri approach. Hoshin Kanri, a lean management methodology, emphasizes clear communication and alignment of objectives across all levels of an organization. It involves the identification of long-term goals, the development of specific action plans, and the implementation of a system for ongoing monitoring and evaluation. This framework is well-suited for the strategic planning of organizing out-of-facility appointments for inmate healthcare as it ensures a comprehensive and coordinated approach to meeting the needs of the patient population. By involving all stakeholders and implementing a robust system for continuous improvement, the Hoshin Kanri approach can support the effective organization of specialty appointments within the given limitations of resources and personnel.

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