Where were you in November, 1976? Maybe not even born yet…but probably not thinking about healthcare in prisons and jails. However, November, 1976 could be deemed the official start of the Legal History of Correctional Nursing. This is the date of the landmark Estelle v Gamble Supreme Court decision which established healthcare as a constitutional right for US inmates based on the 8th Amendment (Cruel and Unusual Punishment).

In an article on the Evolution of Correctional Nursing Practice published in CorrectCare, Mary Muse, RN, MSN noted that organized correctional healthcare was rare at that time. “Before the 1970s, much inmate health care was provided by other inmates, correctional officers and the occasional physician.” The first documentation of correctional nursing may be a 1975 article by Rena Murtha, the Director of Nursing for the New York City Correctional System. In her account, nurses were “a tool of the warden, a slave of the physician and an unknown to the patient.”

Legal History of Correctional Nursing

The Estelle v. Gamble ruling established three basic rights for incarcerated persons based on the fact that they are not free to seek care on their own.

#1 – The right to access to care

This is the primary and fundamental right established by the court decision. There must be capacity to address medical emergencies and provide needed healthcare, including continuation of medical care/management established prior to incarceration.

#2 – The right to care that is ordered

As a follow-up to access to care, once treatment is ordered by a health care professional, that care is to be provided without undue delay.

#3 – The right to a professional medical judgement

The concept of access to care involves the nature and timing of the care such that it is provided by qualified individuals using appropriate equipment, in conducive locations, and for purely medical reasons. Rold, in his excellent article “Thirty Years After Estelle v. Gamble: A Legal Retrospective” cites as an example a 1974 case in which an inmate with a severed ear was treated by having the ear removed and the stump stitched.

The establishment of these three basic healthcare rights for US incarcerated persons became the foundation of healthcare delivery and therefore nursing practice in the corrections environment.