A Minnesota law that limits medical decision-making in jails went into effect July 1 amidst legal filings from Advanced Correctional Healthcare and the Minnesota Sheriffs’ Association. The plaintiffs were granted a temporary restraining order until August 1 to halt enforcement of the law, warning that it could have detrimental consequences.
Statute 241.021 Subd. 4f requires correctional facilities to continue administering medications exactly as prescribed before a person’s incarceration — unless the jail provider can reach the original prescriber, and both parties agree to a change.
Critics don’t disagree that new detainees should receive appropriate medication for their medical conditions, but that medications should not be provided where they would be harmful.
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Jessica Young, Esq., CEO of Advanced Correctional Healthcare stated, “We are sincerely concerned about this statute, as it restricts physicians’ ability to exercise their professional judgment in delivering medical care. Our commitment to patient safety and well-being remains paramount, and we strive to provide individualized treatment within the bounds of legal and ethical standards. This legislation, however, poses challenges to ensuring that each patient receives the most appropriate care tailored to their unique needs.”
Compromising timely clinical judgment
Under normal standards of care, licensed providers evaluate patients based on current symptoms, observed behaviors and the available medical history. Jail intake generally involves people arriving at night, on weekends, or with unstable medical or psychiatric conditions.
Requiring a conversation with an outside prescriber before making any change slows this process — especially when the prescriber is unavailable or unfamiliar with the person’s current status. This can interfere with decisions related to detox symptoms, unstable psychiatric conditions, or inappropriate medication combinations.
“Psychiatric crises and acute withdrawal symptoms don’t wait for callbacks,” said Dr. Melissa Caldwell, PhD, CCHP-MH/A, a clinical-forensic psychologist and co-author of a position paper opposing the law. “The delay caused by mandated consultations can have devastating consequences, particularly in facilities already strained by staff shortages and large patient populations.”
Ignoring the realities of jail medicine
“This kind of legislative overcorrection often comes from advocacy efforts disconnected from the day-to-day practice of correctional medicine,” said correctional health care practitioner Dr. William Dennis, MD, MPH, CCHP-CP. “Rather than empowering providers to improve care, it hamstrings them, forcing them into bureaucratic processes that delay lifesaving interventions.”
Jails are short-term holding environments with rapidly changing populations. It is not unusual for individuals to come in experiencing psychiatric distress, withdrawal, or unmanaged health conditions. Some bring medications from unverified sources, including street providers. Others arrive with prescriptions that are no longer valid or conflict with their current symptoms.
Under the statute, these medications would continue unless strict criteria are met. This reduces providers’ ability to intervene or stabilize care based on what they observe at intake.
For example, an individual who arrives at 1a.m. on a Saturday may discover an unknown pregnancy after receiving a test at intake. Under the statute, the patient would need to continue receiving any current medications despite potential loss of pregnancy or birth defects. The only other recourse would be to write a request to stop the medication cold turkey, which could pose additional health complications. The jail provider could not prescribe an alternative medication without outside approval, which may not be possible for days.
Another real-life example includes an anonymous individual who was booked into jail and tested positive for fentanyl. The patient had a confirmed prescription to manage opioid use disorder (OUD), but ACH staff recognized that providing this medication would lead to an overdose event. The jail practitioner was able to make a timely medical determination to save the patient’s life — something that would not have been possible under the current statute without an agreement from the community prescriber or a written agreement by the patient.
Unequal medical authority
Correctional health professionals argue the statute implies they are unqualified to make medication decisions without outside approval. In any other setting, licensed clinicians assess patients and use their judgment to initiate or adjust treatment. This law blocks that process, giving final say to outside prescribers who may not understand the jail setting or the immediate needs of the person in custody.
Correctional providers are trained to assess for medication misuse, substance interactions and other issues that arise specifically in correctional environments. They are also familiar with the operational constraints of providing care in a secure facility. Under this statute, their clinical evaluation is deferred to those with no direct involvement in the case.
A diabetic individual, for instance, may experience dietary changes in jail that impact their insulin levels. A provider may adjust their insulin doses as appropriate over the course of a patient’s incarceration. Preventing a provider from making these changes without consent from outside providers causes an avoidable delay in personalized medical care. The question remains: why are we asking licensed medical professionals to obtain the approval of a provider who is not able to lay eyes on the patient and who has no understanding of their current situation outside of the current provider’s description?
Emergency departments and hospitals are also raising red flags. Minnesota houses detainees from other states, whose medication histories are often unavailable or unverifiable. Providers say the statute ties the hands of ER doctors who are now forced to continue pre-incarceration prescriptions despite current clinical evaluation.
What reform could look like
Ensuring quality care for incarcerated individuals calls for a collaborative model that honors both patient rights and provider judgment. Effective reform should include:
- Individualized standards for care;
- Clinical autonomy with oversight built on outcomes, not assumptions;
- Timely medication reconciliation processes, with reasonable flexibility;
- Education for legislators and the public on the realities of correctional health care.
The law was triggered by a letter sent to lawmakers by the mother of Larry R. Hill, who tragically died while in custody of a jail unrelated to the plaintiffs. However, the letter of this law would not have prevented Mr. Hill’s death. Ms. Hill writes in her letter that her son’s death was due to the jail’s failure to provide his psychiatric medication. However, his cause of death was due to an underlying and previously unidentified cardiac condition. The unfortunate truth is that no amount of psychiatric medication would have improved Mr. Hill’s heart condition.
Two weeks after receiving Ms. Hill’s letter, both chambers of the legislature and the governor approved the bill. It bypassed public comment, and many medical providers only became aware of the law’s existence after its passage. Minnesota Statute 241.021, Subd. 4f, while drafted with good intentions, ultimately inhibits correctional medical providers from doing what they are trained to do: deliver timely, evidence-based care in a complex environment.
To truly advocate for the health and dignity of incarcerated individuals, we need to trust and empower the professionals who care for them — not obstruct their clinical judgment through stigma-fueled legislation.
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