Preventing Another Fifty Years of Mass Incarceration: How Bioethics Can Help.

In the article "Fifty Years of U.S. Mass Incarceration and What It Means for Bioethics," Sean Valles provides an important reminder of the consequences of mass incarceration in the United States and identifies potential roles for bioethicists in addressing this system.

Understanding US Immigration Detention: Reaffirming Rights and Addressing Social-Structural Determinants of Health.

A crisis of mass immigration detention exists in the United States, which is home to the world's largest immigration detention system. The immigration detention system is legally classified as civil, rather than criminal, and therefore non-punitive. Yet it mimics the criminal incarceration system and holds detained individuals in punitive, prison-like conditions.

Documentation of human rights abuses among Rohingya refugees from Myanmar.

Background: Decades of persecution culminated in a statewide campaign of organized, systematic, and violent eviction of the Rohingya people by the Myanmar government beginning in August 2017. These attacks included the burning of homes and farms, beatings, shootings, sexual violence, summary executions, burying the dead in mass graves, and other atrocities. The Myanmar government has denied any responsibility.

Qualitative evidence of crimes against humanity: the August 2017 attacks on the Rohingya in northern Rakhine State, Myanmar.

Background: The Rohingya ethnic minority population in northern Rakhine state, Myanmar, have experienced some of the most protracted situations of persecution. Government-led clearance operations in August 2017 were one of many, but notably one of the most devastating, attacks on the population. The study aimed to conduct a multiphase mixed-methods assessment of the prevalence and contexts of violence and mortality across affected hamlets in northern Rakhine State during the August 2017 attacks.

Violence and mortality in the Northern Rakhine State of Myanmar, 2017: results of a quantitative survey of surviving community leaders in Bangladesh.

Background: In August, 2017, Myanmar security forces initiated a widespread response against the Rohingya ethnic minority in Northern Rakhine State, displacing thousands of people to Bangladesh. This attack was purportedly in response to attacks committed by the Arakan Rohingya Salvation Army, a non-state insurgent group, on Myanmar police, Border Guard Police, and military posts, killing 12 security personnel on Aug 25, 2017. This study aimed to capture the experiences of the population from all Rohingya hamlets in the Northern Rakhine State who have been displaced to Bangladesh.

IGRA-Based Screening for Latent Tuberculosis Infection in Persons Newly Incarcerated in New York City Jails.

In the United States, latent tuberculosis infection (LTBI) detection in correctional settings is a public health priority. Interferon gamma release assay (IGRA)-based LTBI screening was introduced in New York City jails in 2011 to 2012, replacing historically used tuberculin skin testing (TST), which was associated with substantial incomplete screening rates. This retrospective, cross-sectional study evaluated LTBI screening outcomes and correlates of positivity in 40,986 persons newly incarcerated in 2011 to 2013.

The Rikers Island Hot Spotters: Exploring the Needs of the Most Frequently Incarcerated.

A cohort of frequently incarcerated individuals in the New York City jail system was identified through "hot spotting" analysis. This group demonstrated higher levels of substance use, mental illness, and homelessness than the general jail population, and was typically incarcerated on minor criminal charges. To understand this population better, in-depth interviews (n = 20) were conducted at three Rikers Island correctional facilities with people who had entered the jail system at least 18 times in a six-year period.

Feasibility of Treating Hepatitis C in a Transient Jail Population.

Jails represent a critical component of the public health response to HCV elimination. We report on outcomes of 104 patients receiving HCV treatment from January 1, 2014 to June 30, 2016 in a large urban jail setting. Our data demonstrate that treatment in jails is feasible, but many barriers remain.

Head Trauma in Jail and Implications for Chronic Traumatic Encephalopathy in the United States: Case Report and Results of Injury Surveillance in NYC Jails.

Because there is no standard reporting of injuries in jails and prisons, the national burden of head trauma during incarceration is unclear. We report on a case of repeated head trauma in the New York City (NYC) jail system, data on the incidence of head trauma and mild traumatic brain injury (mTBI), and compare those findings with national estimates. The case report revealed 64 injurious events over two years, 44% resulting in a head injury and 25% resulting in emergency hospitalization.

Death After Jail Release.

The period immediately after release from prison or jail carries increased mortality risk. This study sought to better understand postrelease death by matching electronic health records from those incarcerated in New York City jails between 2011 and 2012 with vital statistics records. The in-jail and 6-week postrelease mortality rates were estimated to be 1.

Correlates of Hepatitis C Virus Infection in the Targeted Testing Program of the New York City Jail System.

Objective: The objective of this study was to understand predictors of hepatitis C virus (HCV) antibody positivity in a large urban jail system in New York City.

Methods: We examined demographic characteristics, risk behaviors, and HCV antibody prevalence among 10 790 jail inmates aged 16 to 86 who were screened from June 13, 2013, to June 13, 2014, based on birth cohort or conventional high-risk criteria. We used logistic regression analysis to determine predictors of HCV antibody positivity.

Staff Satisfaction, Ethical Concerns, and Burnout in the New York City Jail Health System.

This article reviewed a program evaluation conducted among correctional health care staff in New York City (NYC) using a 68-question electronic survey to assess satisfaction, attitudes, and beliefs in relation to ethics and burnout of health care employees in NYC jails. Descriptive statistics were tabulated and reviewed, and further assessment of burnout and ethics was performed through group sessions with participants. This evaluation has led to changes in agency policies and procedures and an emphasis on the human rights issue of the dual loyalty challenges that the security setting places on the overall mission to care for patients.

From Punishment to Treatment: The "Clinical Alternative to Punitive Segregation" (CAPS) Program in New York City Jails.

The proliferation of jails and prisons as places of institutionalization for persons with serious mental illness (SMI) has resulted in many of these patients receiving jail-based punishments, including solitary confinement. Starting in 2013, the New York City (NYC) jail system developed a new treatment unit for persons with SMI who were judged to have violated jail rules (and previously would have been punished with solitary confinement) called the Clinical Alternative to Punitive Segregation (CAPS) unit. CAPS is designed to offer a full range of therapeutic activities and interventions for these patients, including individual and group therapy, art therapy, medication counseling and community meetings.

Improving Transgender Healthcare in the New York City Correctional System.

Purpose: Correctional settings create unique challenges for patients with special needs, including transgender patients, who have an increased rate of overall discrimination, sexual abuse, healthcare disparities, and improper housing. As part of our correctional health quality improvement process, we sought to review and evaluate the adequacy of care for transgender patients in the New York City jail system.

Methods: Using correctional pharmacy records, transgender patients receiving hormonal treatment were identified.

Death Rates among Detained Immigrants in the United States.

The United States system of immigrant detention centers has been the subject of considerable scrutiny with respect to health care of detainees. We sought to characterize the rates and types of deaths that have occurred within this system between the years 2003-2015. We analyzed a file of detainee deaths released by the U.

The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated.

Objectives: We used "hot spotting" to characterize the persons most frequently admitted to the New York City jail system in 2013.

Methods: We used our Correctional Health Services electronic health record to identify 800 patients admitted in 2013 who returned most since November 2008. We compared them to a randomly selected control group of 800 others admitted in 2013, by using descriptive statistics and cross-tabulations, including data through December 2014.

Data-Driven Human Rights: Using Dual Loyalty Trainings to Promote the Care of Vulnerable Patients in Jail.

Dual loyalty is an omnipresent feature of correctional health. As part of a human rights quality improvement committee, and utilizing the unique advantage of a fully integrated electronic health record system, we undertook an assessment of dual loyalty in the New York City jail system. The evaluation revealed significant concerns about the extent to which the mental health service is involved in assessments that are part of the punishment process of the security apparatus.

Disparities in Mental Health Referral and Diagnosis in the New York City Jail Mental Health Service.

Objectives: To better understand jail mental health services entry, we analyzed diagnosis timing relative to solitary confinement, nature of diagnosis, age, and race/ethnicity.

Methods: We analyzed 2011 to 2013 medical records on 45,189 New York City jail first-time admissions.

Results: Of this cohort, 21.

Meaningful Use of an Electronic Health Record in the New York City Jail System.

Use of electronic health records (EHRs) is an important innovation for patients in jails and prisons. Efforts to incentivize health information technology, including the Medicaid EHR Incentive Program, are generally aimed at community providers; however, recent regulation changes allow participation of jail health providers. In the New York City jail system, the Department of Health and Mental Hygiene oversees care delivery and was able to participate in and earn incentives through the Medicaid EHR Incentive Program.

Traumatic Brain Injury Focus Groups as a Means to Understand Violence among Adolescent Males in the NYC Jail System.

Because we previously identified high rates of past TBI among adolescents arriving in the New York City (NYC) jail system we engaged adolescents in nine TBI focus groups to characterize better the level of understanding regarding the relationship between TBI and violence. During these groups, the following themes emerged: 1) physical and psychological impacts of violence; 2) roots of violence; 3) the use of violence as capital in the face of a marginalized social status; and 4) the inevitability of violence, particularly in a jail setting. Although these focus groups were initiated as a means to engage adolescents around the clinical problem of TBI, their observations are strongly centered in the larger context of violence.