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Health Department

Dr. Paul's Tennessean Guest Column - April 17, 2008
Correctional Health Care

Recently it was reported that an inmate at the Metropolitan Correctional Center (MCC) stayed in his cell for nine months, not leaving even for a shower. He was assessed regularly by nurses and mental health staff, and care available to him met national standards. Often he chose to decline it. Inmates, like the rest of us, generally have a right to refuse care, and they may refuse to leave their cell or to take a shower.

This case is unusual and it makes people uncomfortable. Even though access to health care was not an issue in this case, important questions have been raised: Who provides the care? Who is watching to ensure adequate health care is being provided to inmates? Is it enough? Who pays?

The health care (and overall facility management) at MCC is provided by Corrections Corporation of America (CCA) with licensed medical staff on site under a contract with Metro Government. In 2004, the Metro Public Health Department (MPHD) agreed to take responsibility for monitoring the health care provided under that contract. MPHD employees are regularly on site at the facility, meeting with staff and reviewing and auditing records and procedures to ensure that proper care is provided.

Even though CCA hires licensed professionals to provide care in accordance with national standards, Metro has a responsibility to monitor that care to ensure it meets standards, that special needs are taken care of, and that corners are not cut. Both inmate care and contract monitoring do cost taxpayers money, and in annual budget reductions this function competes with other priorities. Apart from MCC, the costs for correctional medical care at the jail have risen to nearly $10 million per year, representing the largest expenditure of MPHD. Positions monitoring correctional health care compete with positions designed to improve the health of infants, youth, families, and neighborhoods.

In the long run, the cost of correctional health care and its monitoring need to be understood as a predictable, obligatory, hard-wired extension of the commitments our community makes to incarcerate people, not as a discretionary activity of the health department. To begin making this case, Sheriff Daron Hall and I appeared together at Mayor Dean's budget hearing to discuss the budget for correctional health care.

In the United States we now have the highest rate of incarceration in the world. No matter how many people we lock up, we have a moral and legal obligation to provide those prisoners with medical care. In a period of shrinking budgets, we need to remain careful when this obligation competes with other important priorities.

William S. Paul, MD, MPH
Director of Health
Metro Public Health Department of Nashville/Davidson County