CSC CAN’T SEE THE MOUNTAIN

When concerns about the health care that offenders receive in our federal prisons is raised with Correctional Service of Canada staffers who can speak to it, there is this incessant insistence that inmates receive the appropriate health care services they need.

That’s not true, and those CSC spokespersons must know that.  There are simply too many complaints.  Are they misled by subordinates, or not following up on what passes in front of them?  Are they misinformed or disinformed?  There’s the rub.  The obfuscation is blinding.  Comparing the dates on health care requests filed by inmates and the dates they received service would prove a point.  The bottom line though is that if someone with a voice at Correctional Service of Canda admitted to health care struggles in the system, then CSC would be expected to do something ‘corrective.’

CSC spends millions every year on health care for inmates in its institutions and the offenders under its supervision in the community.  Because CSC is self-insured, those millions are a part its budget, and incentives are in place to hold the line on expenses.  The issues we have with health care in the community are usually centred on underfunding and staff shortages.  Prison health care is under the same stressors, and perhaps to a greater degree, given its high-needs population.  And since all care is triaged, lag times can be excessive, even for inmates with serious conditions.  It becomes problematic if an inmate is transferred from one institution to another while waiting for help.

There’s an additional irritant impacting the efficacy of prison health care.  Correctional Officers, guards, have a waste-of-skin type prejudice towards the offenders under their care/control.  “We’re treated like dogs; less than dogs,” one inmate lamented.  No question that while there are many guards who comply with their job profile, often in the face of co-worker hostility, inmate degradation prevails all the same.  And it can be infectious.

CSC employs some health care professionals, such as nurses and psychologists, and then contracts for doctors, dentists, psychiatrists, and other relevant specialists.  All are registered or licensed, meet professional standards, and almost universally work to deliver sound medical services.  Nevertheless, anti-inmate bias is frequently evident in the clinics.  One minor example is the response of a nurse to an inmate’s question as he was about to meet with a doctor after waiting weeks for an appointment.  He asked what happens if an inmate’s request for care is marked ‘urgent’.  He quoted her as saying, “Oh, we don’t pay attention to that.”

Then too there is “the challenge of dual loyalties.”  All CSC health care professionals are required to meet The United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) which sets out the terms of dual loyalties for health care as:-
Health care personnel shall not have any role in the imposition of disciplinary sanctions or other restrictive measures.
Confidentiality of medical information is required, unless maintaining such confidentiality would result in a real and imminent threat to the patient or to others.
Clinical decisions may only be taken by the responsible health care professionals and may not be  over-ruled or ignored by non-medical staff. 

To be generous to CSC, the subjectivity here in these three directives is not umpired by empowered third party referees, leaving ample latitude for interpretation.  Plenty of evidence calls for intervention, but management prefers to defer to the muscle in the trenches, falling back on the comfort of the established policies it claims are enforced.  CSC is in a tough spot.  It’s unmanageable; it denies, deflects, and delays, leaving the fallout for Attorney General lawyers to arbitrate.  Our prison industry needs OPCAT (see August 27, 2023).

What happens when an inmate has a toothache?
Stay tuned.

A MOUNTAIN TOO HIGH?

A look at the Correctional Service of Canada’s (CSC) website is a place to start: “…one of our priorities is ensuring that individuals incarcerated in Canada’s federal institutions have access to quality, safe, patient-centred care.”

This is mandated under sections 85, 86, and 87 of the Corrections and Conditional Release Act.  Basically, it says that the Service will give every inmate essential health care, and reasonable access to non-essential health care.  This includes medical, dental, and mental health care delivered by registered professionals or persons acting under their direction.

While there’s no specifics with medical and dental care other than it “shall conform to professionally accepted standards,” it does define mental health care as, “the care of a disorder of thought, mood, perception, orientation or memory that significantly impairs judgement, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life.”

And the Act further stipulates that the Service “shall take into consideration an offender’s state of health and health care needs” in all decisions affecting the offender’s placement, transfer, SIU confinement, disciplinary matters, and preparation for release.

This is CSC’s health care protocol on paper.  It doesn’t always jump off the page into practice.  It often doesn’t jump off the page into practice.  “Health non-care” is a common chorus heard among inmates for what CSC labels as health care.

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Health care in our federal prisons invites constant scrutiny and deserves an exclusive forum which is why, in the absence of dedicated surveillance, this space circles back to the subject frequently.  For this first of the next few postings, a reference from the Office of the Correctional Investigator’s 2018-2019 Annual Report underscores one of CSC’s health care failings.

Correctional Service of Canada facilities across the country include five regional treatment centres for offenders with serious mental health conditions.  Correctional Investigator Dr. Ivan Zinger’s report for that fiscal year focused in one chapter on the difference between protocol and practice for the use of force in the system in general but found “most troubling” the use of force in these RTC’s or psychiatric hospitals.  He exampled an incident at Millhaven RTC in the Bath Institution on the same grounds illustrating a reality in mental health care units.

We reprint it here:

Range video evidence shows an inmate, diagnosed with a serious mental health disorder with significant impairments, engaged in a therapeutic interview with a Behavioural Technologist (BT) in the recreation room.  During the interview, he asks an officer standing nearby at the control post if he could go to the yard for recreation after the interview.  The officer declines, explaining that due to ongoing maintenance work the inmate would have to wait until later.

The inmate becomes agitated, directing a verbal protest towards an officer standing just outside the barrier of the recreation room.  The officer’s response further escalates the situation.  While the BT attempts to de-escalate through verbal coaching, without warning or consultation, officers decide to discontinue the interview due to alleged “staff safety concerns.”  The BT’s report would later state that at no point did s/he feel the inmate had put anyone’s safety at risk, and that the inmate was “appropriate and polite” in all interactions.

An officer opens the barrier and orders the BT “get out of here.”  The BT attempted to leave the area; however, a group of four other officers had already gathered at the exit.  The inmate lunges toward the officers attempting to strike one of them.  The officers charge, tackling him to the floor.  The inmate is held down by the weight of the four officers while lying prone.  A nearby health practitioner reports later that an officer was kneeling across the inmate’s neck and that his face was purple.  The inmate is seen gasping.  One of the officers is reported to have said, “want me to jizz on you face?”  The others are seen laughing on video.

The inmate is handcuffed while on the ground and then lifted and slammed against a steel door, his head pressed against it while being held from the back of his neck.  He is searched while restrained in this position.  He is then escorted, without incident, to an observation cell.

Still handcuffed, he is forced onto the cell bed in a prone position with his face planted firmly onto the metal surface until his handcuffs are removed.  The last officer to exit the cell is seen pinning the inmate’s head to the bed and applying a “pain compliance” technique (forceful twisting and stretching of the arm and wrist) to maintain control as he exits the cell.

This is how CSC mental health care treatment can look in a prison hospital setting, and it’s closer to standard operating practice than it is an isolated incident.

There’s more coming……