Background: It is universal practice to restrain incarcerated patients – regardless of age, illness, mobility, or pretrial status – with metal shackles during hospital stays without consideration for less restrictive alternatives. Globally, human rights and legal groups have voiced opposition to this shackling, citing numerous justice, ethics, and medical concerns relating to the practice. Healthcare institutions are morally obligated to provide equitable, ethical, and humane care that protects the wellbeing and security of patients, yet shackling practices directly contradict this mission.
Purpose: Led by medical students and public health faculty, the Stop Shackling Patients (SSP) Coalition was a task force formed to advocate for revisions to patient care policy at a major metropolitan Level 1 trauma center and academic hospital. Nurses, physicians, medical school faculty, and hospital staff joined this coalition to reassess and revise the existing policies which guide treatment of incarcerated patients. This Coalition empowers healthcare providers and students to spearhead efforts to disestablish the practice of universal shackling at hospitals nationwide.
Description: The Coalition initially synthesized literature on shackling policies and their consequences, summarizing their findings in a nationally-recognized petition. The petition garnered 780 signatures spanning 129 different institutions with the signatories including healthcare professionals, policymakers, and community leaders. Additionally, SSP engaged in discourse with the Massachusetts Medical Society (MMS) through writing a resolution subsequently endorsed by the Committee on Public Health, as well as the Medical Students, Residents, and Fellows sections of the MMS. Most significantly, the Coalition engaged their hospital’s leadership to reform their home institution’s Care of Prisoners policy. The Coalition solicited input from key stakeholders such as hospital security, patient-facing staff, the Office of the General Counsel, and hospital executive leadership to assess their perceptions and concerns. This feedback was used to balance their concerns of safety and liability with patient dignity, and enabled the Coalition to identify shared values of all stakeholders, then translate these principles into new policy. Lastly, the Coalition spread awareness of the human rights and health equity concerns and subsequent policy solution by presenting at hospital rounds and forums of allied health professionals.
Conclusions: When aspiring to change health policy, the specific approach is not always apparent given the myriad of opinions and perspectives raised by stakeholders and pre-existing policies. The advent of the Coalition allowed for efficient progress to be made, while also balancing concerns of a multitude of involved parties. Such collaboration amongst allied health professionals allows for fluid exchange of ideas, shared capital, and pooled resources that will drive further healthcare innovations across the country. This Coalition further allowed for students, faculty and clinicians to challenge entrenched practices within their health systems and systematically change hospital systems.