WITNESS
Robert L. Cohen, M.D., was the Director from 1982 to 1986 of the Montefiore Rikers Island Health Services, which provided care for prisoners in the New York City jail system. Dr. Cohen has been appointed by federal courts to monitor settlement agreements on health care in prisons in Connecticut, New York, Ohio, and Michigan. He sits on the Board of the National Commission on Correctional Health Care, representing the American Public Health Association (APHA). He is also the APHA representative to the Health in Prison Project of the World Health Organization, European Region. He served as associate editor of the first and second editions of Michael Puisis' Textbook of Correctional Medicine, and as an editor of the second and third editions of APHA's Standards for Health Services in Correctional Institutions.
Dr. Cohen was Vice President for Medical Operations of the New York City Health and Hospital Corporations and the Director of the AIDS Center of St. Vincent's Hospital in Manhattan. Dr. Cohen received his M.D. from Rush Medical College in Chicago and his post-graduate training in Internal Medicine at Cook County Hospital in Chicago. He is a Board Certified Internist and practices Internal Medicine in Manhattan.
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STATEMENT
Over two million two hundred thousand men, women, and children are imprisoned in the United States today. Progressive efforts to improve medical care for prisoners have been overwhelmed by the task of providing medical care for more and more prisoners in more and more prisons. Facilitating mass incarceration is not the goal of decent prison medical care. The policy of mass incarceration practiced in the United States, where the rate of incarceration is five to ten times that of Europe, is unsustainable, irrational, and racist. It may not be possible to provide decent medical care for this large a population. The difficult, intransigent problem which must be engaged is the deformation of medical care caused by the fact of incarceration, and the experience of the prison. Prisons are places of violence, and they inure physicians and other health workers to the severe injuries caused by violence, sometimes involving them as participants. Prisoners are seen as less than persons, and their welfare becomes secondary to the welfare of the correctional institution.
There are many physicians whose daily practice contradicts this formulation. They deserve praise and tribute. Compassion is not easily taught, but is effectively ground down by the daily experience of working in prison. Disrespect for prisoners is easily learned. The doctor/patient relationship is often fatally compromised by the transformation of the patient into a prisoner, with a consequent loss of sympathy and standing. It will not be possible to effectively apply the methods of quality assurance to correctional medicine unless health professionals working in prison identify the goal of quality solely as patient welfare. Health professionals must identify with the welfare of their patients, not with the needs of the prison.
Excerpted from a written statement submitted to the Commission
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