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.