'I'm the One With the Degree:' Challenges to Medical Autonomy in Correctional Healthcare in the United States.

Correctional healthcare workers face numerous challenges delivering healthcare to incarcerated patients. This study aims to understand the ways these healthcare workers struggle to assert their medical and clinical independence from custody staff. This study employed a qualitative design, using in-depth interviews with 46 correctional healthcare workers across the United States in 2022. Results indicate that the delivery of correctional healthcare is a product of negotiated order in detention facilities. Participants and custody staff coproduce an informal hierarchy that promotes deference to officers, whereas policies and institutional factors further blur the lines between punishment and care. Healthcare workers also described their strategies for overcoming these issues. Policy implications for improving medical autonomy in correctional healthcare are also discussed.