**5. The safety of incarcerated patients**

The provision of healthcare to prisoners is a complex task, because as discussed earlier in this chapter, prisoners are often at the intersection of multiple vulnerabilities and multifaceted mental and physical conditions affecting their health [14], with treatments undertaken in an environment which is often not under either the patients' or clinicians' control [42, 43].

The irony of prison health is that in some cases treatment within prisons may be the best opportunity an individual has to receive the care they require [21]. This is 'balanced,' however, by the difficulties and barriers which impede such care and which include everything from societal attitudes to prisoners, to clinicians' knowledge and experience of specific conditions and treatments [44]. In between these two extremes are the difficulties faced in both providing and receiving care when the patient frequently has multiple co-morbidities, including mental health issues [45].

Patient safety is defined as the *"… avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare"* [46: 31], which in turn are defined as injuries caused *"… by medical management (rather than the underlying disease) and that prolonged the hospitalization, produced a disability at the time of discharge, or both'* [47: 370]. There are two broad categories of errors – that is errors of commission (where something wrong was done) and errors of omission (where the right thing was not done) [48: n.p.] and three categories of adverse events: *'Preventable adverse events: those that occurred due to error or failure to apply an accepted strategy for prevention; Ameliorable adverse events: events that, while not preventable, could have been less harmful if care had been different;* [and] *adverse events due to negligence: those* 
