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.