{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T19:54:08Z","timestamp":1792958048895,"version":"4.5.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-ioi230073-4\"><jats:title>Importance<\/jats:title><jats:p>Incarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical decision-making processes for hospitalized incarcerated persons who lack decisional capacity.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230073-5\"><jats:title>Objective<\/jats:title><jats:p>To characterize the prevalence of incapacity among hospitalized incarcerated patients and describe the decision-making processes, including who served as surrogate decision-makers, involvement of prison employees in medical decisions, and ethical concerns emerging from the patients\u2019 care.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230073-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Retrospective descriptive and qualitative study of medical records for all patients admitted from prison for at least 24 hours between January 1, 1999, and September 1, 2019, at a large Midwestern academic medical center. Data analysis was performed from March 15, 2021, to December 14, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230073-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Prevalence of prison-to-hospital admissions for patients with a loss of capacity and characteristics of medical decision-making.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230073-8\"><jats:title>Results<\/jats:title><jats:p>During the 20-year study period, 462 patients from the prison were admitted to the hospital, totaling 967 unique admissions. Of these, 131 admissions (14%) involved patients with a loss of capacity and 43 admissions (4%, representing 34 unique patients) required surrogate decision-making. Ten of these patients had advance directives. Surrogate decision-makers often faced decisions about end-of-life care (n\u2009=\u200917) or procedural consent (n\u2009=\u200923). A family member was identified as surrogate decision-maker in 23 admissions. In 6 cases with a kindred surrogate, additional consent was requested from a prison employee. In total, prison employees were documented as being present during or participating in major medical decisions for half of the admissions. Five themes emerged from thematic analysis: uncertainty and misinformation about patient rights and the role of prison employees in medical decision-making with respect to these two themes, privacy violations, deference to prison officials, and estrangement from family and friends outside of the prison.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230073-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this first in-depth description, to date, of decision-making practices for hospitalized incarcerated patients lacking decisional capacity, admissions of these patients generated uncertainty about their rights, sometimes infringing on patients\u2019 privacy and autonomy. Clinicians will encounter incarcerated patients in both hospital and clinic settings and should receive education on how to support ethically and legally sound decision-making practices for this medically vulnerable population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.5794","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T16:00:56Z","timestamp":1701705656000},"page":"28","source":"Crossref","is-referenced-by-count":17,"title":["Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity"],"prefix":"10.1001","volume":"184","author":[{"given":"Sarah","family":"Batbold","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer D.","family":"Duke","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten A.","family":"Riggan","sequence":"additional","affiliation":[{"name":"Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin S.","family":"DeMartino","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota"},{"name":"Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"ioi230073r1","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1001\/jama.284.4.423","article-title":"Aging prisoners stressing health care system.","volume":"292","author":"Mitka","year":"2004","journal-title":"JAMA"},{"issue":"10077","key":"ioi230073r3","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1016\/S0140-6736(17)30259-3","article-title":"Mass incarceration, public health, and widening inequality in the USA.","volume":"389","author":"Wildeman","year":"2017","journal-title":"Lancet"},{"issue":"1","key":"ioi230073r4","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1007\/s11524-011-9614-1","article-title":"Health disparities and the criminal justice system: an agenda for further research and action.","volume":"89","author":"Binswanger","year":"2012","journal-title":"J Urban Health"},{"issue":"6","key":"ioi230073r8","doi-asserted-by":"publisher","first-page":"881","DOI":"10.2105\/AJPH.82.6.881","article-title":"Health status of older male prisoners: a comprehensive survey.","volume":"82","author":"Colsher","year":"1992","journal-title":"Am J Public Health"},{"issue":"10","key":"ioi230073r9","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1016\/j.jagp.2021.05.014","article-title":"Cognitive impairment in older incarcerated males: education and race considerations.","volume":"29","author":"Perez","year":"2021","journal-title":"Am J Geriatr Psychiatry"},{"issue":"4","key":"ioi230073r10","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1111\/jgs.2006.54.issue-4","article-title":"Being old and doing time: functional impairment and adverse experiences of geriatric female prisoners.","volume":"54","author":"Williams","year":"2006","journal-title":"J Am Geriatr Soc"},{"issue":"11","key":"ioi230073r11","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1001\/jamainternmed.2019.3881","article-title":"Acute care for patients who are incarcerated: a review.","volume":"179","author":"Haber","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"7","key":"ioi230073r12","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1001\/jamainternmed.2019.1386","article-title":"Surrogate decision making for incarcerated patients.","volume":"179","author":"Scarlet","year":"2019","journal-title":"JAMA Intern Med"},{"issue":"9","key":"ioi230073r13","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis.","volume":"15","author":"Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"15","key":"ioi230073r16","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1056\/NEJMms1611497","article-title":"Who decides when a patient can\u2019t? 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