How Should Surgeons Help Formerly Incarcerated Patients With Chronic Surgical Needs Maintain Care Continuity?
Year: 2025
Type: article
Abstract: Stoma care is very challenging, and, with the added hardship of incarceration, patients find it very difficult to navigate living with a stoma and having it reversed in a timely fashion.Incarceration history adds to the clinical and ethical complexity of surgical care for patients who require an ostomy, especially when secondary to trauma.This commentary on a case canvasses strategies for responding to long-term needs of formerly incarcerated patients with an ostomy who need good follow-up care as much as they need support reintegrating into communities.Case MM is a 24-year-old man who sustained 3-gun shots to his abdomen.MM was taken to the nearest hospital's operating room (OR) for an emergent damage control exploratory laparotomy.MM's planned return to the OR 3 days later resulted in bowel resection, primary gastrointestinal anastomosis, and temporary ostomy bag placement.One week after being shot, MM continues to recover.Dr S can no longer justify MM's stay on clinical grounds and discharges MM to police custody.MM is jailed immediately on a felony charge of illegal firearm possession.MM is convicted of this charge, imprisoned for 3 months, and then released from prison.MM has few resources, struggles to care for his ostomy, and wonders how he will get the follow-up surgical care Dr S and nurses explained to him would be so important.Due to his conviction, MM is unable to find steady employment or sufficient insurance to cover anticipated costs of the ostomy reversal surgery Dr S plans to do.MM does his best to manage his stoma but develops abdominal pain as well as pain around the stoma.His pain finally brings him back to the hospital's emergency department.MM is admitted with infected peristomal wounds, a peristomal hernia, and stomal prolapse.Dr S and members of their clinical team resume MM's care and wonder what they should do to help MM continue to have access to the staged, longitudinal surgical care plan interventions that are regarded as standard of care for patients like MM.
Source: The AMA Journal of Ethic
Authors: Christine Nembhard, Kindha Nasef
Institutions: Howard University, Howard University Hospital
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4409058974