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Volume 12
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Perspective

“Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury

by
Siddhi S. Ganesh
1,*,
Kyle B. Joyner
2,
Shamsher Samra
3,
Ricky N. Bluthenthal
1 and
Todd W. Schneberk
2
1
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
2
Los Angeles General Medical Center, Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, 1200 N State St, Los Angeles, CA 90033, USA
3
Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
*
Author to whom correspondence should be addressed.
Healthcare 2024, 12(13), 1354; https://doi.org/10.3390/healthcare12131354
Submission received: 12 June 2024 / Revised: 3 July 2024 / Accepted: 3 July 2024 / Published: 7 July 2024
(This article belongs to the Special Issue A Needle in a Haystack: Looking for Gaps in Treatment and Education in Emergency Medicine)
Versions Notes

Abstract

Adam, a justice-involved young man, was brought into the emergency department at the county hospital in cardiogenic shock due to a recurring episode of injection-drug-use-related infective endocarditis (IDU-IE). Adam had initiated injection opioid use in prison. He was surgically treated for the previous episodes of IDU-IE but was unable to fully recover due to limitations in care within penal medicine. This case report explores the prison as a determinant of health, interactions between clinical, welfare, and penal medicine, to produce and maintain health inequities, and structural drivers of physician moral injury through an interview with Adam and reflexive writings from emergency medicine physicians. This case demonstrates the need for three types of structural health interventions: (1) restorative justice, community-based reentry programs, and housing as welfare medicine, (2) increased harm reduction services across healthcare, especially penal medicine, and (3) equitable institutional protocols (contrary to ambiguous guidelines) to treat clinical conditions like IDU-IE that disproportionately impact structurally vulnerable patients.
Keywords: substance use disorder; incarceration; medication for opioid use disorder; harm reduction; moral injury substance use disorder; incarceration; medication for opioid use disorder; harm reduction; moral injury

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MDPI and ACS Style

Ganesh, S.S.; Joyner, K.B.; Samra, S.; Bluthenthal, R.N.; Schneberk, T.W. “Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury. Healthcare 2024, 12, 1354. https://doi.org/10.3390/healthcare12131354

AMA Style

Ganesh SS, Joyner KB, Samra S, Bluthenthal RN, Schneberk TW. “Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury. Healthcare. 2024; 12(13):1354. https://doi.org/10.3390/healthcare12131354

Chicago/Turabian Style

Ganesh, Siddhi S., Kyle B. Joyner, Shamsher Samra, Ricky N. Bluthenthal, and Todd W. Schneberk. 2024. "“Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury" Healthcare 12, no. 13: 1354. https://doi.org/10.3390/healthcare12131354

APA Style

Ganesh, S. S., Joyner, K. B., Samra, S., Bluthenthal, R. N., & Schneberk, T. W. (2024). “Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again”: How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury. Healthcare, 12(13), 1354. https://doi.org/10.3390/healthcare12131354

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