Year: 2025
Type: article
Abstract: Patients who are incarcerated experience severely restricted autonomy and are thus extremely vulnerable.This commentary on a case offers longitudinal, long-term postsurgical trauma-informed care recommendations and starts with a working assumption that, when injuries sustained during incarceration require surgery and hospitalization, patients' rights to evidence-based standard of care that would be given to any other patient should not be compromised.Yet surgical care of traumatically injured patients who are incarcerated can be ethically and clinically complex due to their status as wards of the state, which abrogates their liberty to make their own health decisions.Patients who are incarcerated also have preexisting trauma and are at risk for violence and persistent traumatic stress.Case CC is a 43-year-old patient who presented as a high-level trauma code to the emergency department after an altercation in his prison.Epidural hematoma was suspected immediately upon his arrival, and, during diagnostic imaging, CC became obtunded.A neurosurgeon, Dr N, was consulted and CC was taken emergently to the operating room for a craniotomy and transferred to the neurosurgical intensive care unit (ICU).A tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube were placed for prolonged ventilatory support and enteral nutrition.CC regains capacity to interact meaningfully with others after 2 months in the ICU.CC is weaned from the ventilator, continues to breathe room air via tracheostomy-mask; CC's central line is removed, but a PEG tube and Foley catheter remain in place.CC is anxious and agitated and does not remember why they are in the hospital.Dr R, a surgical fellow, wonders how to respond to CC's questions about their injuries, surgical recovery, and returning to prison.Commentary Care of the patient who is incarcerated is often complicated due to the decreased level of autonomy and privacy afforded to the carceral population.Patients who experience a physically traumatic event while incarcerated are often left with psychological trauma
Source: The AMA Journal of Ethic
Authors: Wynne Q. Zhang, Lucas A. Dvoracek
Institution: Baylor College of Medicine
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4409058923