……TO EXPECT ANYONE TO CARE

The College of Family Physicians of Canada’s 2016 overview of health care in jails/prisons had three key points.
1)  The health of persons who experience detention or incarceration in provincial, territorial and federal facilities is poor compared with the general Canadian population.
2)  Health status data can be used to improve health care services and health for this population, with potential benefits for all Canadians……The time in custody provides an opportunity to intervene.  (Emphasis is ours.)
3)  Information on health status is also important for defining areas of focus for improving health and health care…..the lack of data on some key indicators of health is striking.

The College recommended that provinces and territories transfer responsibility for inmate medical and mental health care from their ministries of justice to the ministries of health.  Similarly, delivery of medical and mental health care services in federal prisons be “separated completely from the Department of Justice Canada.”

Today, the CFPC continues to speak out on the care prisoners receive.

)()(

The Corrections and Conditional Release Act requires Correctional Service of Canada to provide health care to federal prisoners.  This was confirmed in law by Harnois v Canada (Attorney General) in 2010 when an inmate with multiple medical conditions went before the Federal Court to compel CSC to allow him to receive treatment from the same physician who looked after him in the community.

In part, the prisoner claimed a right to a doctor of his choice because the CCRA does not limit this right.  The Court decided that if legislators wanted prisoners to have a right to a doctor of choice, it would have been clearly indicated in the Act.  Further, the Court confirmed the Act makes an institution’s doctor the arbiter of an inmate’s health care.  The Court wasn’t asked to rule on limitations in CSC’s formulary but did find that available treatments met medical standards.

One last point to be taken from this decision is the Court noted the absence of a complaint or grievance from the inmate.  The inmate didn’t file a grievance against CSC over the treatment and care he received.  The grievance process is primarily a sop, of little importance or value offered to stop complaints or unhappiness, as one dictionary defines it.  Inmates should be warned though that this is a necessary step for the record, regardless of how little import it has.

)()(

Legal actions against Correctional Service of Canada citing health care deficiencies are ongoing and will persist, given that advocacy groups will join the lawsuits.  One that has attracted media attention began with 39-year-old federal inmate Michael Devlin, in custody since he was 17, who claims his care for a bad back was not up to medical standards while in custody at Atlantic Institution in New Brunswick, or Springhill Institution in Nova Scotia, or in Millhaven Institution in Ontario.  The John Howard Society has joined in the action because Devlin’s experience is shared by many prisoners helped by the organization.

Catherine Latimer, the Society’s executive director, said the statement of claim, filed with the Supreme Court of Nova Scotia, “indicates that he’s experienced the deterioration of his health and considerable amount of pain and suffering, as a result of the delays in his treatment, and the inadequacy of the treatment that he received.  We will be introducing evidence from prisoners from across the country who have experienced similar issues to Mr. Devlin.”

Latimer remembers the case of a prisoner who was in pain due to deteriorating hip joints and required hip replacements.  CSC told him the surgery was expensive and he would have to wait until he was paroled, even though he was not parole eligible for another 30 years.  Treatments are often delayed because health care for paroled inmates becomes a provincial responsibility.

Leandra Keren’s summation from her December 1^st Toronto Star column:  “Prisoners are denied their liberty, not their right to health care.  The inhumanity and injustice of excluding them from our universal health care protections and allowing them to suffer needlessly with inadequate medical services must end.”

Right?  Right!

Next:  Poor health care can lead to poor outcomes….including death.

……TO NEED HELP

When Kingston Penitentiary was still a prison years ago and not the tourist attraction it’s become, an inmate with a toothache followed procedure and filled out a request to see the dentist.  And then he waited, as is also a part of procedure with health-care in the prison industry.  And he waited.  By the time two other inmates were hospitalized and put on intravenous antibiotics because of delays in dental care, this inmate was in pain constantly.

His family had had enough, stepped up and wrote to the Assistant Commissioner, Health Services at the Correctional Service of Canada national headquarters in Ottawa.  She acknowledged the family’s concern, passed the information to the Deputy Commissioner at the regional headquarters in Kingston, who called the family with assurances that something would be done.  That’s not usual.  Does it pay to go to the top?

And something was done.  This prisoner was escorted to a dentist in the community, where an examination had the dentist concerned and distressed.  He told this man that he had been asked to only do an assessment, but he couldn’t believe that the prison had left him in the state he was in, and he would help him if he wanted.  Three teeth were removed, possibly four, and they were extracted in blackened pieces.  The inmate didn’t care; he only wanted relief.

)()(

This dentist knew the fault did not lie with dentistry.  He knew CSC contracted for a dentist to service inmates in the institution for a specified number of hours/visits per week, or month.  What couldn’t be done within those parameters was left undone.  And this community dentist couldn’t complain after seeing this patient.  CSC is a major employer in Kingston and his practice would easily be negatively affected if he spoke up.

“We believe that that’s really the crux of the issue.  When your jailor is your health-care provider, it creates an irreconcilable set of conflicts,” said Catherin Latimer, executive director of the John Howard Society of Canada.  “As the jailor, you’re preoccupied with security issues and fiscal issues, and those often trump the medical needs of the individual prisoner.”

The John Howard Society wants to see CSC out of the health-care business and care for federal prisoners delivered by those who provide health-care in the community under the Canada Health Care Act.  Having jailors deliver health-care inevitably leads to substandard and unaccountable care.  JHS is not the first to make this recommendation; the Office of the Correctional Investigator has chimed in over the years more than once.

)()(

An active inmate in his mid-40s suffers a knee injury in the gym.  He thinks a few days rest is the solution.  The discomfort continues, he asks for help and is diagnosed with either a tear in a tendon or a meniscus by the institution’s doctor.  Surgery is the remedy.  That was almost three years ago.  COVID has negatively impacted hospital services, but restrictions are being lifted and hospital procedures have resumed.  This inmate recently had a virtual doctor’s appointment to revisit his untreated injury.  The doctor’s response was, “We’ll have to see what can be done about that.”

Leandra Keren, an articling fellow with the John Howard Society of Canada who was quoted in the previous entry, “Prison is no place to be unhealthy, sick or injured,” went on to write in her December 1 Toronto Star contribution from last year, “The fox is providing the hens with health-card…..In the eyes of CSC, medical staff, prescription drugs, and specialist consultations, all constitute major costs which detract from CSC’s budget…..This, along with the punitive culture of prisons, results in the mistreatment of prisoners through the denial of their health-care.”

)()(

Did you know…..?
Offenders transferred to a federal prison are assessed by a nurse at reception.  Prescription and over the counter meds are discontinued pending a review by the institution’s doctor.  An inmate does without while waiting. 
Correctional Service of Canada has its own formulary, a list detailing the medicines that may be prescribed.  A doctor cannot prescribe meds the list doesn’t cover which can have a negative impact on treatment options.  As one example, consider the range of drugs available for bi-polar disorder.  Patients may not respond well to one drug, or may get relief for a time, and alternatives are a necessity.  At CSC, only limited meds may be authorized.

Did you know…..?
An inmate who has a complaint against the health-care received from a doctor or a nurse in a federal institution cannot file a complaint with the regulatory colleges for either profession. By doing so, that nurse or doctor against whom the complaint is made cannot continue to treat a patient filing the grievance.  That inmate then has no health-care at all until the matter is resolved.

Next….there’s always a next with prison health-care.