title: Factor for felons: how can we provide haemophilia care to the incarcerated?
abstract: OBJECTIVE
  In 2011, 6.98-million offenders were documented in the adult correctional system, with state operating costs designated 12% towards medical care ($11.97 day per inmate) for the general population. Common co-existing health problems identified are: arthritis (13%), hypertension (11%), asthma (10%) and heart problems (6%). Less than 5% of inmates have health issues related to cancer, diabetes, liver or renal problems and communicable diseases. The leading cause of death is suicide (33.2%), followed by heart disease (26.1%). Despite these statistics quality is lacking. Given these statistics, one would expect that a small proportion of patients from Hemophilia Treatment Center (HTC) will spend some time within the justice system. Currently there are no data addressing haemophilia care needs while incarcerated.
  
  
  METHODS
  This article will review the current health care issues in the adult correctional system. Additionally, six case reports of incarcerated haemophiliacs will be highlighted exploring the successes and challenges with maintaining haemophilia care addressing the priority of meeting the haemophilia care needs verses the penal system regulations.
  
  
  CONCLUSIONS
  It can be expected that at some point, the HTC will experience a patient incarcerated for some period of time. The HTC will continue to advocate for their patient within this system, despite the many challenges faced.
  
  
  CONCLUSIONS
  Despite the challenges outlined, ongoing communication and education with the correctional system, education of the medical personnel and prison personnel remains the priority as we advocate for our patients. Continued strategies in these areas are paramount.
authors.affiliation: Henry Ford and Bleeding and Thrombosis Treatment Center Henry Ford Health System, Detroit, MI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lambing
authors.affiliation: Henry Ford and Bleeding and Thrombosis Treatment Center Henry Ford Health System, Detroit, MI, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kachalsky
authors.affiliation: Henry Ford and Bleeding and Thrombosis Treatment Center Henry Ford Health System, Detroit, MI, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Mueller
authors.affiliation: Henry Ford and Bleeding and Thrombosis Treatment Center Henry Ford Health System, Detroit, MI, USA.
authors.forename: P
authors.initials: P
authors.lastname: Kuriakose
mesh_terms: D000328:Adult; D005169:Factor VIII / Q000627:therapeutic use*; D006282:Health Personnel; D006467:Hemophilia A / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D010344:Patient Advocacy; D005791:Patient Care / Q000379:methods*; D011330:Prisons; D055815:Young Adult
chemical_list: D005169:Factor VIII
keywords: expenditures; haemophilia; health care; prison