In light of the COVID-19 pandemic's disproportionate impact on individuals in congregate settings, such as correctional and immigrant detention facilities, the American Medical Association (AMA) adopted policy today in support of improved public health measures to prevent the spread of SARS-CoV-2, and other contagious infectious diseases, in these settings. The new policy, which was approved by physicians at the Special Meeting of the AMA House of Delegates, calls for all correctional and immigrant detention facilities to implement evidence-based COVID-19 infection prevention and control guidance, have adequate access to personal protective equipment (PPE), testing kits, and sanitizing and disinfecting equipment, and ensure humane, safe quarantine protocols for anyone testing positive for or exposed to SARS-CoV-2.

Recognizing that detention center and correctional workers, incarcerated people, and detained immigrants are at high risk for COVID-19, the new policy also makes clear that these individuals should be prioritized in receiving access to safe, effective COVID-19 vaccines in the initial phases of distribution.

"Throughout the COVID-19 pandemic, we've seen the virus spread quickly in high-density populations, particularly in correctional facilities. Because of the high risk of SARS-CoV-2 infection among people who are incarcerated, and correctional and detention center workers, the AMA is advocating for increased infection control measures, additional PPE, and priority access to vaccines to prevent the spread of COVID-19," said AMA Board Member Ilse R. Levin, D.O., M.P.H & T.M. "Being incarcerated or detained should not be synonymous with being left totally vulnerable to COVID-19. These steps are vital to protect people and stop the spread of the virus."

The new policy also calls for expanded data reporting to include the testing rates and demographic breakdown for SARS-CoV-2 cases, and other contagious infectious diseases, and deaths in correctional and detention facilities.

The COVID-19 pandemic has also highlighted the need for compassionate release, also known as medical release, for incarcerated patients on the basis of serious medical conditions and advanced age. Under the new policy, the AMA supports policies that facilitate compassionate release and will collaborate with appropriate stakeholders to develop clear, evidence-based eligibility criteria for timely compassionate release.

"Given that physicians are required to determine medical eligibility for potential candidates for compassionate release, it is vital that the criteria for eligibility is clear to physicians so they feel comfortable determining if someone meets the criteria without fear of liability," said Dr. Levin.

Additionally, to ensure that compassionate release laws are being implemented consistently, the AMA will support the transparent reporting of compassionate release statistics, including numbers and demographics of applicants, approvals, denials, and revocations, and justifications for decisions.

Under the Sentencing Reform Act of 1984, compassionate release was authorized on the federal level and subsequently adopted by 49 states and the District of Columbia. The use of compassionate release laws has been advocated for as a mechanism to address the growing number of older prisoners, overcrowding, increasing numbers of in-prison deaths, soaring medical costs of the criminal justice system, as well as a matter of medical ethics as the continued incarceration of patients with serious or debilitating illness can constitute a violation of human dignity if appropriate palliative care is unavailable.

In April, the AMA Journal of Ethics featured a discussion on caring for incarcerated individuals during the COVID-19 pandemic.