The United States incarcerates nearly two million people. 1 When medical care for those in jail or prison exceeds the capabilities of the correctional facility's healthcare services, patients are transferred to community medical centers for emergency services, specialty care, and surgery. 2, 3 Given the scale of mass incarceration in the United States and the high burden of disease among incarcerated individuals, 4 many hospital‐based clinicians will provide care for incarcerated patients during their careers even if they never set foot in a jail or prison. Federal law mandates basic healthcare for people who are incarcerated, 5 yet does not define how care is delivered. As a result, patients who are hospitalized while incarcerated experience exceptions to physical comfort, health privacy, and informed decision‐making 6 with little standardization of practices between medical centers. Individual institutional policies then inform the clinical management of incarcerated patients, establishing and perpetuating care norms. Here we use two hospital polices pertaining to the care of patients who are incarcerated within the same state to demonstrate how differing medical center guidelines can drive disparate care practices, explore why divergent practices arise locally and nationally, and propose steps to develop equitable clinical standards across medical institutions.