SPOTLIGHT: PRISON HEALTH CARE – A BOTTOM LINE

“The security features inherent to federal correctional facilities are designed to keep people in as much as they are to keep people out. As a result, the management of the federally-sentenced population is largely conducted away from public scrutiny. Invisible to the general population, federally-sentenced persons are often forgotten.”
The Senate of Canada, Human Rights Committee, Interim Report, February 2019

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These often forgotten inmates in our federal prisons are wholly dependent upon Correctional Service of Canada for the necessities of life, including health care. The Corrections and Conditional Release Act (CCRA) says that CSC is responsible for providing “every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration in the community.”

Despite the millions of dollars budgeted annually for health care and the aggressive treatment targeting some conditions, like HIV and HEP-C, access and timely attention to care is a major source of inmate complaints and grievances. That is a slow and cumbersome process, but inmates can elect to file a complaint through the professional associations of doctors, dentists, and nurses. However, doing that means the incriminated doctor, dentist or nurse cannot treat the complainant during the review process.

Yes, while the voices of inmates are devalued by CSC, there are others who make studied and authoritative assessments that can’t be ignored. Or can they?

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“Healthcare in CSC penitentiaries is not provided independently of corrections. Instead, healthcare providers are employees of CSC, though recently CSC has been making changes purportedly to encourage their independence. This is nevertheless a violation of the Mandela Rules, which requires that prison health services be organized in close relationship to the general public health administration and that medical providers act in full clinical independence.”
West Coast Prison Justice Society, Damage Control, June 2019

“Bill C-83 includes several positive health care obligations, and recognizes the professional and clinical independence of health care professionals, but the legislative requirements are again vague and don’t include enforceable standards. Health care providers should partner with federal and provincial Ministries of Health, without the influence or interference of prison administrators, and without any CSC staff supervision or oversight. And, add legislation to ensure confidentiality between health care providers and prisoner patients.”
Canadian Bar Association, letter to Ottawa on Bill C-83, November 19, 2018

“There are many areas of correctional health care practice that give rise to clinical role conflicts of ethical dilemmas, where clinical independence and professional autonomy may be impaired or impeded or where health care providers may feel compelled to follow correctional authority rather than health care rules.”
Office of the Correctional Investigator, Annual Report, 2017-2018

“The crux of the matter boils down to the fact that role conflicts and misunderstandings between health care and custodial staff are common and everyday occurrences. Examples abound: population movement schedules determine health care clinic hours; when or if an inmate’s medical escort takes place is dependent on staffing levels; who provides care or how it is provided in a prison setting is not a matter of patient choice.”
Ibid.

“….United Nations Standard Minimum Rules for the Treatment of Prisoners (now known as the Mandela Rules)….state that clinical decisions may only be taken by the responsible health care professionals and may not be overruled or ignored by non-medical prison staff. Though a review of the Mandela Rules was purportedly conducted and completed, in response to an Office request for an update, CSC provided no documentation, report or findings to corroborate its claim that CSC health care services are compliant with the Mandela Rules. Saying or believing that the Service is compliant with domestic or international rules and standards is different from demonstrating it. As with many other activities within CSC, transparency would go a long way towards ensuring that health care standards behind bars are demonstrably met.”
Ibid.

“Federally-sentenced persons also provided the committee with disturbing personal accounts of health and dental care services, most often involving doctors or dentists hired by the CSC on contract. On the other hand, some federally-sentenced persons had a more positive view of certain mental health nurses and clinical social workers with whom they were in contact but felt that they had inadequate access to these professionals, especially outside of normal business hours. In other words, a mental health crisis should occur between 9:00 a.m. to 5:00 p.m., Monday to Friday in order for the affected individual to receive help. Overall, the committee has heard many examples of how security concerns of staff routinely trump health – especially mental health – needs of prisoners.”
The Senate of Canada, Human Rights Committee, Interim Report, February 2019

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This is a sampling of what is in front of the federal government and Correctional Service of Canada. They’re from the latest of a long list of opinions, research, studies and examinations over many years that have called for change.

One bottom line sees the appointment of a Minister who chooses to manage rather than be managed.