Prison Doctors

The New Orleans Times Picayune, following its usual practice of passing off editorials as front-page news, reports that most of the physicians working full-time at the state’s prisons have been disciplined by the state medical board. Of the fifteen full-time doctors, two have been in federal prison, five are still on probation, and, altogether, nine have received board sanctions.  Their legal problems appear to have been mainly substance abuse and sexual misbehavior.  The article identifies one former prison doctor as having had a history of malpractice, but apparently none of the current medical care providers have records of malpractice or incompetence. Nevertheless, the author of the article assumes that their past offences make them dangerous. “At stake,”  pronounces reporter/editorialist Cindy Chang, is the health of 19,000 prisoners who are among the most vulnerable of patients because they cannot go to another doctor.”  Chang provides no evidence that medical care in Louisiana prisons is any worse than the prisoners would be receiving if they were on the outside or even that it is any worse than the care available to Americans in general.  Still, this lack of relevant evidence does not prevent her from intoning, “Louisiana prisons appear to be dumping grounds for doctors who are unable to find employment elsewhere because of their checkered pasts, raising troubling moral questions, as well as the specter of an accident waiting to happen.”

Now, here are some facts to consider before we start becoming morally troubled: The United States currently has a serious shortage of physicians.  Few who have other choices would opt to work full-time in a prison. The salaries the Louisiana prison system can offer its doctors (mostly in the low six-figures) are more than most workers make, but less than most other doctors earn. Finding decent medical care for prisoners, then, is a real problem.  If these individuals with “checkered pasts” were not there, the alternative would probably be fewer prison doctors.

It’s possible that a prisoner may receive less than the best possible treatment from a resentful doctor with no alternative. It is also possible that a doctor will be so grateful at getting a second chance that he will be especially devoted to the prisoner-patients. I can’t say which of these possibilities I would put my money on because the only information Chang gives us about the doctors is their rap sheets. But I think that putting apparently competent doctors who have no opportunities for practice outside the institutions together with patients that very few doctors want to serve is not a problem at all, but a good solution.

Beyond the fact that Chang’s article is basically an opinion piece, and belongs in the editorial section of the paper, it seems to me to exemplify a wider tendency in thinking about “social problems.” This is the tendency to assume an ideal state of affairs (everyone should have access the best possible medical care) and then to issue moral pronouncements against efforts to find workable responses to complicated realities.