….WHEN YOU HAVE A TOOTHACHE IN PRISON?

“The lack of accountability CSC provides its physicians also allows for the negative stigma associated with criminal behaviour to infect those treating prisoners,” is from one of the media releases by Executive Director Catherine Latimer of the John Howard Society of Canada.

Prison inmates are no angels, and interactions with health care professionals can be difficult in some cases, but there is no place in the law or in our collective conscience for negative branding.  As omnipresent as it is throughout the penal system, the health care professionals treating incarcerated patients do well to recall our Supreme Court reminder that it is who we are, and not who they are, that governs our actions.  The few dissenters tarnish the reputation of their vocation, but any prison health care worker is under some pressure to compromise.

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You have a toothache, or otherwise need the attention of a dentist.  Only fear or uninsured expenses stand in the way of asking for help.  You can be in a dentist’s chair within hours if necessary.  That’s not so in our federal prisons.

“Miss, I have a toothache.”  Most inmates will see or pass by a nurse daily.  “Put in a requisition,” will be the response.  That’s the routine; use the institution’s internal mail system to ask for a dental appointment, and then wait.  Wait to be called to health care when your turn comes up.

How long is the wait?  That depends.  That depends on how a need is triaged, at times without the input of a dentist, and sometimes it depends on the health care unit’s subjective assessment of the needs of individual inmates.  Then too, because inmates don’t have advance notices of appointments, the call to a range to send an inmate to health care may not get to the patient, in which case the record will show that the inmate ‘refused’ to attend.  But, when an inmate doesn’t show up for an appointment, why doesn’t health care double-check with the guards on the range?  Why not?  There should be a concern for why the appointment was missed.

There is much anecdotal evidence of the impact of delayed dental care on inmates.  From two inmates in a Kingston institution a few years ago who were put in hospital on intravenous antibiotics to combat infections while waiting months for care, to a more recent case of an inmate in Quebec with a badly swollen jaw and cheek who could squeeze puss out of his tear duct be applying pressure under his eye.  These men must have been suffering through heavy pain with no recourse but to wait for help, not knowing when that help would arrive, and hopefully with the resources to pay for expensive prison black-market illicit drugs for relief.

Dentists are authorized to provide basic and essential care and from all accounts they are diligent in their service within the contractual limits and imposed time constraints.  Government bureaucracy and the proverbial red tape can prolong contract renewals for medical services, and the maximum number of dental clinic hours allowed in those contracts are often insufficient to meet patient needs.  In the case of the former, there are no dental appointments in institutions waiting new contacts, and with the latter, too few treatment hours leave some inmates on long waiting lists.

Looking at terms in some recent agreements, Collins Bay Institution in Kingson can accommodate up to 750 inmates, but a dentist is on site there a maximum of 12 hours a week.  Warkworth about two hours away allows 1 day a week, about 6 hours, for a population of up to 537.  Millhaven in Bath has contracted for a maximum of 364 hours a year, averaging 7 hours a week over a 52-week year.  In some prisons, dentists may book clinics (about 6 hours) according to need but only up to the contracted maximum number of hours.

While contracts prescribe a maximum number of hours, no dentist has spare openings for prison patients.  What’s more, internal institutional issues affecting inmate movement and incidents that lead to lockdowns will delay or cancel health care appointments.  Security trumps toothaches.

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Brennan Guigue’s inmate activism makes him a primary source of information, and this segment on prison access to dentists will end with one of his past oral health care experiences.

He was in Millhaven Institution at the beginning of 2019.  He’d been suffering with toothaches for a few months and was making futile requests for help.  He didn’t know then that CSC was still negotiating a new contract for dental services, and in the meantime, patients would have to wait.  Anxiety and discomfort exacerbated his distress as he watched what other inmates were going through.

We stepped in, expecting an intervention would be in vain.  Letters went to the institution, to the Assistant Commissioner for Health Services at CSC national headquarter in Ottawa, and to the Ontario regional headquarters in Kingston.  Eventually, a call from Ian Irving at the regional headquarters assured us that Brennan would be taken to a dentist.

By the first half of March, he had been transferred to Collins Bay temporarily due to operational issues.  He was taken from there to a Canadian Forces Base Kingson dentist on Monday, March 25, where x-rays were taken, as CSC had requested.  The dentist was concerned by the images, checked Brennan’s mouth, and felt he couldn’t let Brennan leave his office without help if he wanted it.

(“I can’t believe they left you in this condition.”)

Four teeth were extracted, including the 1-8 (upper right molar) which had a cavity and the beginning of an abscess, plus three others that were broken, pitted, blackened and rotting. The dentist gave him care instructions, a minimum supply of pain killers, and told him four other cavities needed attention but were not emergencies.

Brennan saw a dentist at Millhaven on Wednesday, May 8.

More prison health care, next…….