What is custodial medicine?

What, some may ask, is custodial medicine? From a forensic perspective, it is the provision of clinical and forensic medical services in the custodial setting whether it be in the prison or in police custody. Custodial medicine is an all-encompassing area of forensic medicine that deals with a variety of issues from the medical care of detainees to issues of specimen collection and fitness for police interview. Although many doctors know how to treat specific medical conditions, this area, like occupational health, is all about how to deal with specific medical conditions within the confines of a system, the system here being the custodial system. Custodial systems vary from jurisdiction to jurisdiction but the principles generally remain the same.

Doctors working in this area are regularly faced with ethical dilemmas. These occur due to the conflicting priorities of medical care and the requirements of the correctional system and/or police. Within the correctional system, the primary purpose of the prison is to confine persons accused or convicted of a crime for particular periods of time. It is not there primary for the provision of health care. This healthcare is subsequently provided in the setting of institutional requirements, budgetary limitations and public and legislative pressures. Similarly police detain persons for the purpose of protecting the population temporally from that person and/or to investigate a crime. Their view of the person is not as a patient but as a possible crime scene. Both situations can and do place the doctor in a setting of conflicting priorities, i.e. healthcare vs correctional/custodial/legal requirements. The work can be very challenging.