While most prison healthcare litigation seeks individual relief, some cases lead to broader
structural reform via consent decrees — court-approved “legally binding performance improvement plans” designed to improve conditions. This study, published in Social Sciences, systematically analyzes 121 such settlements from 1970 to 2022 to assess their policy goals and implementation strategies. It identifies the substantive areas targeted — general medical care, mental health, dental services, and treatment for specialized conditions like HIV, Hepatitis C, and COVID19 — and trace trends across time and geography.

The findings suggest that consent decrees function not only as judicial remedies but also as tools of policy development and institutional reform, shedding light on the role of courts in shaping correctional healthcare delivery. These findings also show how institutional responses to healthcare failures in prisons shape the conditions under which serious harm — and in some cases, preventable death — occur behind bars.