SPOTLIGHT: WHOSE HEALTH CARE IS IT, ANYWAY?

“The sole task of health care providers in correctional settings is to provide health care with undivided loyalty to the patients, with unrestricted clinical independence, acting as the patient’s personal caregiver without becoming involved in any medical actions that are not in the interest of the patient health and well-being.”
Pont, Engglist, et al, American Journal of Public Health, April 2018

Health care in the prison systems was previously framed in “Scene One” on March 3rd of this year, and “Scene Two” on April 14 where a note pointed to a future third entry about dental care in federal institutions. Those first two postings were necessarily harsh as inmates can run into problems accessing reliable care due to “dual loyalties” among some health care workers.

Nurses, psychologists, pharmacists and social workers are employees of Correctional Service of Canada, whereas doctors and dentists are contracted. The focus here is dentistry.

A toothache is distracting, uncomfortable, and left untreated, can result in excruciating pain and a serious infection. As previously noted, inmates submit a written request for health care and then wait for attention. It’s unlikely an inmate will ask for a dentist unless there is some urgency, but a nurse is just as unlikely to consult promptly with an inmate when a request is received by the health care unit.

Sit and wait. It’s not unusual to wait weeks or even months to see the institution’s dentist, and aside from knowing there is a waiting list for treatment, an inmate doesn’t know when help will come. For the most part, a dentist’s time is managed at the discretion of the institution’s on-site health care workers who generally don’t recognize the word “emergency.”

Dental services are contracted and so too are the number of service hours, often expressed as a maximum number of hours per year. For example, the dentist who services Millhaven Institution in Bath with roughly 500 potential patients is available a maximum of 364 hours a year, and may run one to three clinics a month, depending on need which is established by institutional nurses. Joyceville Institution in Kingston has up to 637 hours a year for about 750, Collins Bay in Kingston a maximum of 644 hours per year for 760, and Warkworth Institution in Campbellford lists dental services one day a week for just over 500. And, all managed by institutional employees.

Given the ratio of hours to population, dental therapies are more curative than preventive. There are examples of people waiting so long for help they’re admitted to institutional hospitals on IVs to fight infections. There are examples of inmates taken to outside dentists for help when advocates press CSC national headquarters and regional offices for action. Too, outside referrals can be critical of the damage delays can cause.

To be fair, negative experiences with institutional dental services are not entirely universal. An inmate can feel ignored at one point but get help in reasonably short order another time. Consistency is illusive. The culprit? Refer to the first paragraph.

Part II of the spotlight on health care follows.

SPOTLIGHT: WHY THIS JUST WON’T GO AWAY

The controversy and legal actions over the use of solitary confinement in provincial jails and federal prisons has been a media staple for the last many years. This site has reported at least twice on the practice of separating inmates from population (“The Canadian Bar Association comments” – March 17/19 & “Solitary Confinement” – February 3/19).

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The previous Ontario government hired former federal correctional investigator Howard Sapers to recommend reforms to provincial jail policies, including a rethink of the segregation of inmates, sometimes up to 24 hours a day which contradicted even the existing guidelines. Ontario employed Sapers in response to court rulings against established policies, but the ministry’s later revisions limiting segregation practices didn’t necessarily make for major changes.

Jail guards in Ontario adapted. One method that created quasi-segregation conditions when an inmate could not be placed in old solitary cells was to substitute the most remote cell on a range. Since new rules required a certain number of hours out of a cell, those hours were timed to when other inmates were locked up.

The effectiveness of the reforms in Ontario jails depends upon the willingness of management to do just that….manage. Meanwhile, some provinces continue to use solitary confinement as a recourse for inmates who are aggressive, suicidal, mentally unstable, or as reprisal for anything not meeting staff approval. Whether it’s a provincial or the federal government, the one option to force change is the courts, and the stamina to withstand appeals.

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The government of Canada has been in the courts for years, first arguing its support for Correctional Service of Canada’s existing prison policies, particularly with the use of solitary confinement, and then appealing decisions that have gone against it. Actions challenging the prison agency have been centered in British Columbia and Ontario where rulings have either been upheld on appeal or are pending.

Knowing the jig is up, the government tabled Bill C-83 last year which it claimed did away with solitary confinement, passed it to committee, sent it on to the Senate which returned a package of amendments that the Commons rejected, shepherd it through third reading, and received Royal Assent this summer.

Bill C-83 is now law. Rather than segregating federal prisoners who are a risk to security or themselves, inmates would be moved to “structured intervention units” (SIUs) where they are intended to get “better programming,” more mental health care and more contact with others.

Firstly, not all institutions have a range of programming even for inmates in population. What does “better programming” for SIU inmates mean in those prisons? Notably, a group of over 100 lawyers and academics sent a letter to the Senate while that body was considering the legislation to say that SIUs “continue to be solitary confinement under another name.” It claimed that without the Senate amendments the bill “specifically allows for prolonged solitary confinement without independent oversight. This is a clear violation of international human rights.”

Ralph Goodale, the minister responsible for CSC, argued Bill C-83 includes independent oversight through “independent external decision makers” without specifying the process for selecting candidates, the qualifications expected, or how appointments would be made. Senator Kim Pate, a member of the Senate Human Rights Committee and a lifelong advocate for prisoners’ rights, questioned how independent the new external reviewers will be if chosen by the minister. Senator Pate claims that without judicial oversight the law will be unconstitutional. Expect to see more lawsuits, no matter which party forms the next government.

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Here’s a thought. Nobody has to tell government prison agencies how harmful and damaging solitary confinement is under most conditions. They’re on the front lines. They know the downsides. So, for one, why should it be left to civilian bodies and the courts to force governments to do the right thing? Why aren’t our elected bodies and the public servants working under them leading the way to long overdue reforms?

What’s more, once the system failures have come to light, why isn’t CSC and its provincial counterparts openly interacting with the courts and the public to find solutions to effectively manage difficult institutional inmate crises?

Why are they so afraid of the light?

…….one last ‘switch’.…..

Jason Godin, former national president of the Union of Canadian Correctional Officers, and a founding member of the organization representing 7,300 federal correctional officers in Canada, left the top post on May 9 after three years in office, and 18 years on the union executive after its 2001 inception.

He is a man of long and broad experience. And yet, in a brief interview last year when commenting on changes Correctional Service of Canada was making to the inmate grievance mechanism, he welcomed the revisions as a foil to what he considered nuisances. Disparaging inmate protests is self-serving when Mr. Godin knows offenders often have legitimate cause, and he’s only too familiar with the use prison guards themselves make of a grievance system when they claim management is not acting in their best interests.

As it was, filing a grievance was cumbersome and potentially risky for an inmate, responses often slow in coming….sometimes up to a year or more…, and upwards of 95% were summarily dismissed without community standard due process. The modifications are unwieldy and discouraging, and while they may not be intentionally inhibiting, there’s no question that they are. It all comes across as only a sop for appeasing the prison population.

Inmates have two redress tools. They can hire a lawyer and take CSC to court, or they can file a grievance. One is out of reach for most, and the other is out of touch. How does this square with the rehabilitative ideals of ‘corrections’?

Prison reform activists have been challenged for decades by questions around accountability and transparency issues within our penal systems. Correctional Service of Canada protocols for candid dialog, for ‘opening the books’, for welcoming scrutiny is like the pendulum of a great clock. It swings freely and with abandon, but the scope of the arc is strictly confined.

There are places out of reach. Or is there? As an example, it’s here that one difference prison guards have with firefighters and police officers is apparent. No matter what perspective one has of police conduct in our communities, the shield sheltering the integrity of cops against charges of impropriety is not as insulating as the firewall that protects and ensures the security of guards. (see “The Firewall” posted November 4 of 2018) Why is this necessary? With the constant interaction between guards and inmates, the efficacy of the prison landscape benefits from the viewpoints of all parties.

And what does hope have to do with carrots? Inmates know. CSC assessments maximize the negative and minimize the positive, battering the hope offenders may clutch for a better tomorrow. While the correction plan assigned to all prisoners offers pathways to that new day, too often the lures are the proverbial carrots on a stick that lead down a road of hope-bashing obstacles.

Lastly, here’s a question. Who will finally take the lead and rectify the joke our last Conservative government made of inmate pay scales?

……two spotlights on the way.