Sick in prison. Death in prison.

Port Cartier Institution is a maximum-security prison with a small inmate population located outside the town of Port Cartier in far eastern Quebec on the north shore of the St. Lawrence.  Opened in 1988, it was built to boost employment opportunities in an area represented in parliament at the time by Brian Mulroney.  He was the member for the electoral district of Manicouagan and the Prime Minister.

The prison is a remote 600 kilometres from Quebec City and roughly a 14-hour drive from Montreal.  This increases operating costs.  Staffers travelling to Montreal or Ottawa must drive 60 kilometres further east to Sept-Iles and fly from there.  And, to meet Correctional Service of Canada’s mandate to encourage inmate contact with the community, visitors can be reimbursed for some travel costs.  It’s a long way from home.

Several years ago, a contact in the institution was placed in segregation for a time.  An elderly inmate was in the next cell, old and feeble and out of his mind.  He muttered through the day, had nothing but bedding and a few clothes, and spent at least some of his time painting the walls with his own feces.  Once a day, two guards would take him to the shower while his cell was hosed down.  This man lived in segregation with only himself for company, and he wasn’t there serving an institutional sentence.  He was intentionally hidden away, and by now has more than likely died, his only relief.  Why was he still in prison?

This is an evident example of cruel and unusual punishment, and it didn’t have to be.  Correctional Investigator Ivan Zinger has pointed out that “prisons were never meant to house sick, palliative or terminally ill patients.”  Just so, the legislation and policies which direct Correctional Service of Canada and the National Parole Board allows for compassionate release of sick inmates to hospices, nursing homes and long-term care facilities.

The release authorization process is slow and cumbersome to the point that sick inmates often die before their request is considered.  CSC recently developed its own MAID policy to accommodate inmates who don’t want to suffer through an often futile wait for a decision, but even that is a process.  There’s no question a sick inmate does not want to die in a prison environment, but notices are posted on the CSC website almost weekly announcing deaths from “natural causes.”

In this age of COVID, we frequently hear of sick patients dying in hospital alone, with only nurses and doctors for comfort.  A tragic death we’re told, and so it is.  Death in a prison infirmary is singularly solitary. No one cares.

Should we?  A moral tale may illustrate the conundrum.

A man has a dog, a faithful friend, a part of the family for years, a friend who walks with him every day in the ravine down the road.  There comes a time when the walk in the woods turns deadly.  His dog runs on ahead, an old habit, and encounters a predator….a coyote.  The man runs towards the sound of howls, growls, and barks, picking up a broken tree limb as he goes.  He reaches the fighting animals as the coyote tears at his dog’s throat.  He beats viciously on it  until it rolls away, bleeding, whining, gasping on the ground.  His dog is dead.  The man picks up his old friend to carry him away and pauses to look down at the coyote.  The animal is laying on its side, quivering, breathing heavily, mortally injured.  What does the man do?

)()(

The state of health care in the prison industry is dismal despite the tens of millions of dollars spent by provincial and federal carceral agencies.  The need for services by the imprisoned is substantially higher than in the general population and explains in part the disparity between what is done and what is left undone.  The challenge in finding health-care staff who give a damn about outcomes is another piece to the answer.

From a lawyer in Quebec who specializes in post-conviction law we learn that “almost all federal prisoners are dealing with at least one serious medical problem and a quarter of the population are(sic) aggravated by health services which range from slow to spotty to forget-about-it.”  Over 40% of men and women sitting in provincial jails awaiting trial have mental/emotional health issues.  Our jails and prisons have become our largest provider of mental health services, and warehouses for the mentally ill.  And yet, most are left untreated in any meaningful way in spite of what CSC wants to tell us about the role of psychologists in the federal system.

Whether a decayed tooth, a broken bone, a diseased body or mind, the call for care tests the capacity to respond.  Imagine for instance the anxiety of a provincial prisoner who is transferred to the federal system where their prescribed medication is cut off until the federal health-care unit does a reassessment and may change or not renew an established regimen.  Imagine having to wait weeks with a toothache.  Imagine knowing you must live with bi-polar disorder because the treatment you need is not forthcoming.  Imagine men and women punished rather than treated because illness causes them to act out.

Institutional healthcare has been and will continue to be dissected here and elsewhere.  Changes?  Improvements?  Incrementally, yes, maybe.

There’s a long way yet to go.  For now, we move on.

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