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Reconsidering the public health failings of the criminal justice system: a reflection on the case of… Kerr, Thomas Aug 15, 2006

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ralssBioMed CentHarm Reduction JournalOpen AcceCommentaryReconsidering the public health failings of the criminal justice system: a reflection on the case of Scott OrtizThomas Kerr*1,2Address: 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver BC V6Z 1Y6, Canada and 2Department of Medicine, University of British Columbia, 3300-950 West 10th Avenue, Vancouver BC V5Z 4E3, CanadaEmail: Thomas Kerr* - tkerr@cfenet.ubc.ca* Corresponding author    AbstractThroughout most of the world, the primary response to the health and social impacts of illicit druguse has been to intensify the enforcement of drug laws. The consequences of this policy approachinclude an unprecedented growth in prison populations and increasing concerns regarding drug-related harms within prisons and without, including increased risk of HIV and hepatitis C (HCV)infection. This has led to calls from public health and prisoner advocacy groups to prison authoritiesto improve health services available in the community and those available to prisoners. Whileconsiderable progress has been made with respect to the growing implementation of HIV and HCVprevention measures within some nations' prisons, the case of Scott Ortiz illuminates a new set ofchallenges for prisoners and their advocates as judges often have a faulty understanding of publichealth arguments and data. In this case we see one such instance where a judge acts in ways notrooted in sound public health evidence or practice to produce a perverse outcome that violatesboth sound medical and judicial objectives.BackgroundThroughout most of the world, the primary response tothe health and social impacts of illicit drug use has beento intensify the enforcement of drug laws in an effort tolimit the supply and use of illicit drugs [1]. The conse-quences of this policy approach include an unprecedentedgrowth in prison populations and increasing concernsregarding drug-related harms within prisons [2]. In recentyears, incarceration has been associated with an array ofharms, including increased risk of HIV and hepatitis C(HCV) infection that results from injecting that occurs inprisons in the absence of effective prevention measuressuch as syringe exchange programs [3]. This has led tocalls from public health and prisoner advocacy groups towhich states that health services available in the commu-nity must also be made equally available to prisoners [3].While considerable progress has been made with respectto the growing implementation of HIV and HCV preven-tion measures within prisons, the case of Scott Ortiz illu-minates a new set of challenges for prisoners and theiradvocates. Mr. Ortiz is described as a former injectiondrug user who had been convicted of burglary. Upon con-clusion of Mr. Ortiz's trial, the presiding judge imposed anextraordinary and lengthy sentence based on a publichealth argument that was not rooted in sound publichealth evidence or practice. In short, Mr. Ortiz was con-victed as a means of reducing the likelihood that he mightPublished: 15 August 2006Harm Reduction Journal 2006, 3:25 doi:10.1186/1477-7517-3-25Received: 27 July 2006Accepted: 15 August 2006This article is available from: http://www.harmreductionjournal.com/content/3/1/25© 2006 Kerr; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 2(page number not for citation purposes)prison authorities to honor the 'principle of equivalence' transmit his infectious diseases to others through illicitdrug use. Aside from being tragic, this decision was alsoPublish with BioMed Central   and  every scientist can read your work free of charge"BioMed Central will be the most significant development for disseminating the results of biomedical research in our lifetime."Sir Paul Nurse, Cancer Research UKYour research papers will be:available free of charge to the entire biomedical communitypeer reviewed and published immediately upon acceptancecited in PubMed and archived on PubMed Central Harm Reduction Journal 2006, 3:25 http://www.harmreductionjournal.com/content/3/1/25ironic given what is known about the high risk injectingenvironments within prisons. If Mr. Ortiz was in fact anactive injector or a past injector who returned to injectingwithin prison, it is clear that greater individual and publichealth-related harm would result from incarcerating him.But, more importantly, the sentence given to Mr. Ortizsuggests that, even when there is no clear legal or publicsafety rationale for lengthy incarceration, former or cur-rent injection drug users may face significant discrimina-tion and potential harm through sentencing erroneouslydesigned to protect public health.The use of sentencing of injection drug users to protectpublic health represents a rather disturbing developmentin the realm of drug policy and illustrates the extent towhich dominant social narratives that portray drug usersas reckless and lacking regard for the health of others havepenetrated the judiciary. This is particularly disturbinggiven the power and independence afforded to the judi-cial system. Further, the case of Mr. Ortiz also demon-strates how the blurring of criminal justice and healthsystems responses to drug use seems to continuouslypresent new harms, as custody and control repeatedlytrump efforts to protect and promote individual health.Given the current dominance of enforcement and incar-ceration in drug policy, the case of Mr. Ortiz suggests newwork for public health practitioners, prisoner advocates,and legal reformers, with ignorance and discriminationwithin the judiciary being the main target for action.Correction is a public safety rather than a public healthactivity, and therefore the justice system and prison lifeitself are not organized in accordance with public healthprinciples. Prevention and care of diseases does, in someinstances, require the difficult task of reconciling or bal-ancing a public health model of prevention, diagnosis,care, and treatment with the correctional requirements ofcustody and control [4]. However, such a balancing act inno way indicates a role for the judiciary in preventinginfectious disease transmission by incarcerating thosewhom an individual judge deems to pose a risk as a resultof their past or current illicit drug use. Let us only hopethat the tragic story of Mr. Ortiz ignites new action thatultimately serves to prevent or at least limit the use of lawand order as a tool of public health.References1. Wodak A: Drug laws. War on drugs does more harm thangood.  BMJ 2001, 323:866.2. Drucker E: Drug prohibition and public health: 25 years of evi-dence.  Public Health Rep 1999, 114:14-29.3. Kerr T, Wood E, Betteridge G, Lines R, Jurgens R: Harm reductionin prisons: a 'rights based analysis'.  Critical Public Health 2004,14:345-60.4. Dubler N, Bergmann C, Frankel M: Management of HIV infectionin New York State prisons.  Columbia Human Rights Law Review yours — you keep the copyrightSubmit your manuscript here:http://www.biomedcentral.com/info/publishing_adv.aspBioMedcentralPage 2 of 2(page number not for citation purposes)1990, 21:363-5.

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