PhD Dissertation Defense

Date: Tuesday, May 27, 2025

Time: 11:00 a.m. – 1:00 p.m. PST

Location: Social Ecology I, Room 315 – Zoom: https://uci.zoom.us/meeting/register/1GigqQgdRVSQxMueT-8Vcw

Regulation by Litigation in Correctional Health Services: a Mixed-Methods Policy Implementation Study

Abstract: The quality of healthcare provided in prison is a critical focus of academic and policy discussions. With the vast number of people entering U.S. prisons disproportionately suffering from poor health, and with serious barriers to achieving quality medical care, policymakers and health care providers often struggle to find solutions to meet health needs in the nation’s prisons. This dissertation explores how one approach, healthcare-related consent decrees and settlement agreements, are used to reform healthcare in U.S. prisons. Are they a worthwhile tool?

This exploratory sequential mixed-methods dissertation includes four essays:

• Essay 1 reviews case law and legislation grounding the constitutional right to healthcare in prisons and examines how legal framing shapes how incarcerated people and their advocates fight for quality care.
• Essay 2 presents a systematic content analysis of 121 consent decrees and settlement agreements from a civil rights litigation database. This analysis finds that, unlike other prison litigation, healthcare decrees have been national in scope. Despite barriers like the Prison Litigation Reform Act (PLRA), consent decree provisions persist and influence both general and condition-specific medical care, including treatment for HIV, Hepatitis C, and COVID-19.
• Essay 3 presents a thematic analysis of interviews with monitors appointed to oversee these agreements. Successful implementation depended on respectful relationships, leadership support and receptive prisons, and early planning. Key barriers included fiscal constraints, which limited service expansion and hiring, making funding essential for progress.
• Essay 4 examines trends in correctional health spending and assesses whether consent decrees are associated with increased investment. While spending has generally tracked broader national healthcare trends, consent decrees did not correlate with higher correctional health spending in recent years. The essay also designs a staggered difference-in-differences model better suited to evaluate implementation effects.

Together, this project answers policy questions about how litigation affects the organization and improvement of correctional health services, addresses theoretical questions about the ability of courts to affect social change, and fills a gap in the policy implementation literature on courts as actors in health policy implementation.