Dual loyalties 1.10
Other interests
Prison doctors must, however, be aware that it is not only the administration that could be interested in restricting the distribution of health care. Health care is an attractive service that sometimes guards, on the custodial side, and unofficial 'bosses', among the prisoners, often like to control for monetary gain. This would be a form of corruption from the custodial point of view - however, in many countries, the guards' salaries are so low, that this can hardly be called corruption in the western sense of the word - illicit monetary gain - but rather a form of survival.
Medications can be used as a kind of informal currency for purposes such as gambling, bribing guards, paying debts or passing on 'cash' to needy relatives outside the prison. If the prison doctor discloses such irregularities, he or she should report them to the prison officials, and if they do not take action she/he must report to relevant bodies outside the prison. It must be realised that this is easier said than done. Prison guards, prison nurses, even doctors often have extremely low salaries, often insufficient even by local standards to maintain a family. The essential point here is that the patient receives the necessary treatment.
In conflicting situations the doctor should always press for the health interests of the patient regardless of pressure from others.