Although the 18th-century penitentiary was concerned both to punish and rehabilitate inmates, little priority was given to inmate health care. In subsequent centuries, the American courts interpreted the law so as to leave the scope and quality of inmate health care to the discretion of correctional authorities. In the landmark U.S. Supreme Court case of Estelle v. Gamble (1976), however, the Court stated that persons have a constitutionally protected right to medical care when incarcerated. Subsequent court rulings clarified this right to include care for mental illness. Under these court mandates, prisons or jails can be ordered to alter those aspects of their health care delivery system that led to the violation at issue. In addition to systems that permit inmates to communicate with the health care unit without hindrance, constitutionally adequate access to care requires an ancillary system under which medical and mental health care providers can reach out to the inmates who may not be able to communicate their needs directly. Other health-care mandates for inmates are the right to confidentiality in doctor-patient communications, the right to refuse care, and the right to adequate care. 14 references