One prison……One health care follow-up

HEALTH CARE IN FEDERAL PRISONS is a frequent feature here over the last many months, and periodically going back years.  Care of prison inmates is high profile and despite ongoing recommendations from monitors and critics on the one side, and some positive feedback from Correctional Service of Canada on the other, how much has really changed in the trenches?

Numerous letters to responsible parties regarding one inmate in one institution were posted in this space during June and July, along with the few responses.  The access and availability of mental/emotional health care services for Brennan Guigue at Port-Cartier Institution in Quebec predominated the exchanges but his physiological issues were also appended.

We contacted CSC Assistant Commissioner Health Services Jennifer Wheatley, Acting Assistant Commissioner Health Services Manjeet Sethi, both at CSC National Headquarters in Ottawa, the Regional Director of Health Services at Quebec Regional Office in Laval, and Marco Mendicino, Canada’s Public Safety minister who is charged with overseeing federal prisons.  Also included were Nadia Pelletier, Health Care Services at Port-Cartier Institution, Ivan Zinger, Canada’s Correctional Investigator, and Derek Janhevich, the correctional investigator’s Director of Investigations for Ontario and Quebec.

This collates into a neat file, but to what end?  The correctional investigator’s office arranged for one of its staff investigators to interview Brennan Guigue during a trip to Port-Cartier Institution, a visit coincidentally scheduled just as this came to their attention.  That meeting came to naught when the investigator listened for about ten minutes to Brennan’s concerns, and then told him he could not be of help!  Isn’t that the purpose of Ivan Zinger’s agency?

Manjeet Sethi in Ottawa used files on record to challenge the claim that Brennan Guigue was not getting help and argued that he even refused attention, but then offered an assurance that the inmate was getting all necessary care, and further help was always available.  That was emphatically refuted, and Mr. Sethi was sent a 40-page psychiatric assessment to underscore CSC’s neglect.  Brennan Guigue wanted to mail out the written requests he had been sending to the health care unit in Port-Cartier as a rebuttal, along with the responses, but he was not permitted to do so.

Okay, so what came of this?  Well, to this point anywhere from very little to nothing.  There’s been more transparency specific to Brennan Guigue’s concerns but it’s only possible any will be addressed.  More importantly, this ‘noise’ attracted CSC’s attention, enough to warrant having Port-Cartier Institution’s health care unit meet with Brennan Guigue to review his complaints, and then also meet by telephone with me.

Nadia Pelletier is on leave.  Kim Morin, a nurse, is overseeing the health care unit at Port-Cartier.  She met with Brennan Guigue for at least an hour on July 15 to discuss his requests for mental health counselling and his unresolved complaints about reduced suboxone dosages.  Our 20–25-minute conversation followed on Tuesday afternoon, August 2.  In a move unusual for a CSC staffer, Ms. Morin began both conversations noting her preference for open discussions rather than simply taking authoritative postures.  Outcomes may not differ, but back-and-forth exchanges reveal more detailed information.

Kim Morin can’t overrule a doctor, acknowledged a review of the suboxone prescription is in order, but left this in Brennan’s hands.  He previously filed a complaint with Quebec’s College of Physicians, and I doubled down in our conversation later with Ms. Morin, suggesting another complaint would be filed if the doctor continued to defer.

Inmate requests for mental health care are triaged, Brennan learned, and with limited staff in high-needs prison populations, access can be worse than in the community.  Brennan has been waiting for years.  Except for CSC’s five or six treatment centres, these conditions are the norm in the system.  Port Cartier, for instance, has one psychiatrist who is in-house one day every month or two, plus two staff psychologists.

My conversation with Ms. Morin went further, digging into Brennan’s atrial fibrillation diagnosis at Port Cartier some time ago.  She opened his medical file as we spoke.  It noted he had an ECG last December which showed no arrhythmia.  Symptoms persist.  She suggested that perhaps he should have more frequent tests, but it was far from a commitment.

That same file made no reference to his left knee when I brought it up although Brennan was diagnosed with a torn meniscus or damaged ligament over two years ago.  Ms. Morin supposed she might have to search for information, again not exactly a commitment.  I sent her a letter on that subject, which read in part:-

“I can tell you that health care at Warkworth Institution requested an MRI for that knee.  When Brennan was transferred to Millhaven, the institution’s doctor there saw this in the file and then added his own recommendation.  The doctor at Port-Cartier did meet with him on the issue but, according to Brennan, did not even get up from behind his desk to do an examination.  In the meantime, the left knee joint is causing increasing difficulties.

Brennan told me recently that he wondered if making a request for help was worthwhile, given that no serious attention was paid to an earlier submission.

With this update, and your additional search of his records, I assume an MRI can be scheduled in due course to lead to a remedy to prevent additional damage to the joint.”

Prison health care has been, is, and is destined to always be a tragic contradiction to rehabilitation, unless and until courageous political will make it otherwise.

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Prisons – lost opportunities?

“The core mandate of our correctional system is to rehabilitate and safely reintegrate offenders into our communities.  To achieve this objective, the Correctional Service of Canada (CSC) is committed to providing safe environments for those who work or live in its correctional institutions.”  CSC news release May 11, 2022

Too many prison inmates are as prepared to return to the community as contributing law-abiding citizens when they are released as any of us is prepared to be an astronaut on a moon mission.

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Consider the impact of institutionalization for example.  That’s the process where a person becomes unable to live independently because they are used to living in an institution.  That’s one source’s definition for this condition that counteracts a successful reintegration for ex-prisoners.

CSC knows what institutionalization is, can define it, and understands how vulnerable populations are affected.  To the degree that it feels a need to clarify how it deals with this, our prison industry might point to a step-down resocialization process by lowering inmate security classification levels, from maximum to medium to minimum to half-way houses to community supervision.  Nonetheless, CSC will release inmates directly from medium and even maximum-security facilities under supervision, either at statutory release or warrant expiry.

But simply giving an offender more freedom and flexibility can leave many feeling rudderless, not knowing what to do with it.  To boot, the CSC response to someone struggling in a more open environment is to increase security, including reincarceration from half-way houses.  What’s missing is a pro-active targeted supportive process that starts at day-one of a sentence and is ongoing for as long as CSC exercises control.

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“Rehabilitate and safely reintegrate offenders into our communities.”  How is CSC doing that now? A sampling:  programs that target criminality and address mental/emotional disorders and addictions, education, relevant job skill’s training, relevant life-affirming cultural initiatives, spiritual guidance, volunteer-run 12-step groups and socialization activities like book clubs and discussion/debate roundtables.

Keeping COVID restrictions in mind, all of this has been, is, or will be again available in federal institutions across Canada.   Sounds good.  Right?  But all options are never available in any one institution with only a few available in most institutions.  Maximum-security prisons often have next to nothing for inmate participation.  In far too many places and for too many inmates, choices are limited to sleeping away much of the day, watching television, playing video games, doing a turn around the yard, or taking an hour in the gym.  Staff negativity and hostility further exacerbate the challenges.  How does that meet CSC’s mandate?

There are a limited number of part-time institutional jobs that do nothing to prepare ex-cons for a competitive employment market.  CORCAN, CSC’s agency that offers some substantive job-training programs, has few openings in few institutions.  And as a CORCAN spokesperson conceded here some months ago, most positions are simply intended to fill an inmate’s time.

Most telling is a total absence in our prisons of any up-to-date computer technology, training, programming, or internet access, making Canada a stand-out in western world ‘corrections.’

What’s left in the end is a few excellent opportunities for less than a hundred inmates out of thousands.  While secondary school courses are widely available, going further is next to impossible without computer access.  How many colleges/universities still offer correspondence courses?  As for correctional/rehabilitative programming, one inmate described them as cookie-cutter modules, a template CSC uses as a model for all.

Could this be tokenism?

Look at it this way.  Five-day ‘work weeks’ must be available to all inmates at every security level, designed as a multi-pronged and progressive pathway toward contributing to the society they’ve offended and not simply as rehabilitation toward a safe reintegration.  Potential ‘opt-outs,’ possibly many, would be thoroughly screened by qualified professionals to ensure they understand the ramifications of their choices.

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What’s standing in the way of making a Service out of an Industry?  Budget constraints perhaps?  Then how does Correctional Service of Canada meet its mandate without funding?  And if there are behind-the-scenes negotiations, then why doesn’t the landscape change?

Does Correctional Service of Canada care about outcomes?