Hey, I’m the patient!

SPOTLIGHT: WHOSE HEALTH CARE IS IT, ANYWAY?

“The sole task of health care providers in correctional settings is to provide health care with undivided loyalty to the patients, with unrestricted clinical independence, acting as the patient’s personal caregiver without becoming involved in any medical actions that are not in the interest of the patient health and well-being.”
Pont, Engglist, et al, American Journal of Public Health, April 2018

Health care in the prison systems was previously framed in “Scene One” on March 3rd of this year, and “Scene Two” on April 14 where a note pointed to a future third entry about dental care in federal institutions. Those first two postings were necessarily harsh as inmates can run into problems accessing reliable care due to “dual loyalties” among some health care workers.

Nurses, psychologists, pharmacists and social workers are employees of Correctional Service of Canada, whereas doctors and dentists are contracted. The focus here is dentistry.

A toothache is distracting, uncomfortable, and left untreated, can result in excruciating pain and a serious infection. As previously noted, inmates submit a written request for health care and then wait for attention. It’s unlikely an inmate will ask for a dentist unless there is some urgency, but a nurse is just as unlikely to consult promptly with an inmate when a request is received by the health care unit.

Sit and wait. It’s not unusual to wait weeks or even months to see the institution’s dentist, and aside from knowing there is a waiting list for treatment, an inmate doesn’t know when help will come. For the most part, a dentist’s time is managed at the discretion of the institution’s on-site health care workers who generally don’t recognize the word “emergency.”

Dental services are contracted and so too are the number of service hours, often expressed as a maximum number of hours per year. For example, the dentist who services Millhaven Institution in Bath with roughly 500 potential patients is available a maximum of 364 hours a year, and may run one to three clinics a month, depending on need which is established by institutional nurses. Joyceville Institution in Kingston has up to 637 hours a year for about 750, Collins Bay in Kingston a maximum of 644 hours per year for 760, and Warkworth Institution in Campbellford lists dental services one day a week for just over 500. And, all managed by institutional employees.

Given the ratio of hours to population, dental therapies are more curative than preventive. There are examples of people waiting so long for help they’re admitted to institutional hospitals on IVs to fight infections. There are examples of inmates taken to outside dentists for help when advocates press CSC national headquarters and regional offices for action. Too, outside referrals can be critical of the damage delays can cause.

To be fair, negative experiences with institutional dental services are not entirely universal. An inmate can feel ignored at one point but get help in reasonably short order another time. Consistency is illusive. The culprit? Refer to the first paragraph.

Part II of the spotlight on health care follows.

Solitary confinement & the prison industry.

SPOTLIGHT: WHY THIS JUST WON’T GO AWAY

The controversy and legal actions over the use of solitary confinement in provincial jails and federal prisons has been a media staple for the last many years. This site has reported at least twice on the practice of separating inmates from population (“The Canadian Bar Association comments” – March 17/19 & “Solitary Confinement” – February 3/19).

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The previous Ontario government hired former federal correctional investigator Howard Sapers to recommend reforms to provincial jail policies, including a rethink of the segregation of inmates, sometimes up to 24 hours a day which contradicted even the existing guidelines. Ontario employed Sapers in response to court rulings against established policies, but the ministry’s later revisions limiting segregation practices didn’t necessarily make for major changes.

Jail guards in Ontario adapted. One method that created quasi-segregation conditions when an inmate could not be placed in old solitary cells was to substitute the most remote cell on a range. Since new rules required a certain number of hours out of a cell, those hours were timed to when other inmates were locked up.

The effectiveness of the reforms in Ontario jails depends upon the willingness of management to do just that….manage. Meanwhile, some provinces continue to use solitary confinement as a recourse for inmates who are aggressive, suicidal, mentally unstable, or as reprisal for anything not meeting staff approval. Whether it’s a provincial or the federal government, the one option to force change is the courts, and the stamina to withstand appeals.

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The government of Canada has been in the courts for years, first arguing its support for Correctional Service of Canada’s existing prison policies, particularly with the use of solitary confinement, and then appealing decisions that have gone against it. Actions challenging the prison agency have been centered in British Columbia and Ontario where rulings have either been upheld on appeal or are pending.

Knowing the jig is up, the government tabled Bill C-83 last year which it claimed did away with solitary confinement, passed it to committee, sent it on to the Senate which returned a package of amendments that the Commons rejected, shepherd it through third reading, and received Royal Assent this summer.

Bill C-83 is now law. Rather than segregating federal prisoners who are a risk to security or themselves, inmates would be moved to “structured intervention units” (SIUs) where they are intended to get “better programming,” more mental health care and more contact with others.

Firstly, not all institutions have a range of programming even for inmates in population. What does “better programming” for SIU inmates mean in those prisons? Notably, a group of over 100 lawyers and academics sent a letter to the Senate while that body was considering the legislation to say that SIUs “continue to be solitary confinement under another name.” It claimed that without the Senate amendments the bill “specifically allows for prolonged solitary confinement without independent oversight. This is a clear violation of international human rights.”

Ralph Goodale, the minister responsible for CSC, argued Bill C-83 includes independent oversight through “independent external decision makers” without specifying the process for selecting candidates, the qualifications expected, or how appointments would be made. Senator Kim Pate, a member of the Senate Human Rights Committee and a lifelong advocate for prisoners’ rights, questioned how independent the new external reviewers will be if chosen by the minister. Senator Pate claims that without judicial oversight the law will be unconstitutional. Expect to see more lawsuits, no matter which party forms the next government.

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Here’s a thought. Nobody has to tell government prison agencies how harmful and damaging solitary confinement is under most conditions. They’re on the front lines. They know the downsides. So, for one, why should it be left to civilian bodies and the courts to force governments to do the right thing? Why aren’t our elected bodies and the public servants working under them leading the way to long overdue reforms?

What’s more, once the system failures have come to light, why isn’t CSC and its provincial counterparts openly interacting with the courts and the public to find solutions to effectively manage difficult institutional inmate crises?

Why are they so afraid of the light?

Hope is not a carrot.

…….one last ‘switch’.…..

Jason Godin, former national president of the Union of Canadian Correctional Officers, and a founding member of the organization representing 7,300 federal correctional officers in Canada, left the top post on May 9 after three years in office, and 18 years on the union executive after its 2001 inception.

He is a man of long and broad experience. And yet, in a brief interview last year when commenting on changes Correctional Service of Canada was making to the inmate grievance mechanism, he welcomed the revisions as a foil to what he considered nuisances. Disparaging inmate protests is self-serving when Mr. Godin knows offenders often have legitimate cause, and he’s only too familiar with the use prison guards themselves make of a grievance system when they claim management is not acting in their best interests.

As it was, filing a grievance was cumbersome and potentially risky for an inmate, responses often slow in coming….sometimes up to a year or more…, and upwards of 95% were summarily dismissed without community standard due process. The modifications are unwieldy and discouraging, and while they may not be intentionally inhibiting, there’s no question that they are. It all comes across as only a sop for appeasing the prison population.

Inmates have two redress tools. They can hire a lawyer and take CSC to court, or they can file a grievance. One is out of reach for most, and the other is out of touch. How does this square with the rehabilitative ideals of ‘corrections’?

Prison reform activists have been challenged for decades by questions around accountability and transparency issues within our penal systems. Correctional Service of Canada protocols for candid dialog, for ‘opening the books’, for welcoming scrutiny is like the pendulum of a great clock. It swings freely and with abandon, but the scope of the arc is strictly confined.

There are places out of reach. Or is there? As an example, it’s here that one difference prison guards have with firefighters and police officers is apparent. No matter what perspective one has of police conduct in our communities, the shield sheltering the integrity of cops against charges of impropriety is not as insulating as the firewall that protects and ensures the security of guards. (see “The Firewall” posted November 4 of 2018) Why is this necessary? With the constant interaction between guards and inmates, the efficacy of the prison landscape benefits from the viewpoints of all parties.

And what does hope have to do with carrots? Inmates know. CSC assessments maximize the negative and minimize the positive, battering the hope offenders may clutch for a better tomorrow. While the correction plan assigned to all prisoners offers pathways to that new day, too often the lures are the proverbial carrots on a stick that lead down a road of hope-bashing obstacles.

Lastly, here’s a question. Who will finally take the lead and rectify the joke our last Conservative government made of inmate pay scales?

……two spotlights on the way.

Prison light switch #4……

……taking it easy on the system – for a change.

The prison environment is punitive by necessity. That’s why Correctional Investigator Ivan Zinger says offenders are sent to prison as punishment and not for punishment. Even in those European models where dynamic security measures in some institutions means inmates are not locked in their cells, and where programs permit some to spend weekends with their families in the community, a prison is still a prison.

Almost all offenders in Canadian federal institutions will return to the community, and Correctional Service of Canada has a mandate to assist with that often difficult transition by maximizing opportunities for success. Putting health care aside for a later date, there are aspects of prison life today that support an affinity with life in the community, there are elements that can be massaged to do the same, and there are progressive proposals to be considered.

In June of last year, it was announced two prison farms in Ontario would reopen this summer. The program officially relaunched two days ago at Collins Bay and the farms there and at Joyceville are now ramping up operations. The Pen Farm Herd Co-op was among a diverse group of farmers and social justice advocates working to re-establish these training opportunities since the previous federal government closed the last farm in 2010. Great move!

Book Clubs for Inmates is a registered charity that organizes volunteer-led reading groups to improve inmate literacy. Since retired Anglican priest Carol Finlay initiated the program in Collins Bay in 2008, clubs are now operating in 36 institutions across the country.

James Fox, a California-based instructor founded the Prison Yoga Project in 2010 which has spread to 300 U.S. prisons in 28 States. He began a training course in Vancouver in June of this year to prepare teachers for Canadian prisons and is in the process now of dealing with the delays and difficulties navigating through our government bureaucracy.

A prison needle exchange program is rolling out across Canada. There are pluses and minuses. It’s controversial. Guards here demonstrate in opposition to what they see as a threat. Various models in countries which have prison needle exchanges include two where needles are stored in plastic safety cases. One commonality throughout however is that inmates in every country have complaints about how these programs are structured.

Death, dying and MAID in prison is a challenge looking for a speedy resolution. CSC has been developing a protocol around medical assistance in dying but the bottom line in every instance is the same. No terminally ill man or women should die in prison when a preferable alternative is readily available, either for palliative care or an assisted death. The present cumbersome compassionate release process begs for prompt action to expedite quick transfers when time is short.

Stepping onto rocky, difficult terrain, consider appropriate and case-specific programming at all security levels for inmates who spend as much time out of their cells as is possible to schedule. Then, to push the envelope further, reimagine the previously tested safe tattooing program by auditing earlier outcomes to determine the benefits of a revised blueprint. And to put a period on this segment, a revision of the tobacco ban along with ongoing anti-smoking initiates would impact the pervasive prison black market for a saner environment.

One thing that won’t change. Prison is still prison.

……another switch? ……on the way.

Prison light switch #3……

…..now to continue.

SECURITY: ……in the dictionary as protection and safeguards, as well as care, custody and sanctuary, and then further as assurance, certainty and reliance, we live increasingly in a risk-averse environment, a symptom of our changing world.

The conspicuous presence of security measures conditions us to see potential threats as ever-present, a boon to a growing industry. But, the best training programs encompass a range of assessment techniques in applying appropriate responses to whatever situations arise. A street is not shut down because a shoplifter was at work in the corner store.

Prison security touches all areas of institutional operations and exercises a top to bottom priority over every detail of procedure and practice. This degree of authority and autonomy is condoned and expected under the circumstances, and the perception that control is absolute is as important as is the fact of it.

In a democracy, great power comes with great responsibility. We assume without a second thought that the men and women responsible for security in our institutions execute their obligations keeping the base purpose of a correctional system in mind. It’s one thing to take necessary measures to manage pressing concerns but disrupting programs and routines beyond the resolution is counterproductive. Tempering safeguards with an eye to the certainty of long-term expectations is a protocol worth pursuing.

GUARDS: Police officers, firefighters, and correctional officers have a commonality. All who work in these jobs do so by choice, knowing assignments can be volatile, dangerous, and potentially lethal. Depending on postings, there is also considerable down time where staff are still expected to be vigilant, watchful, and ever ready on stand-by, and this despite a lack of stimulation. The differences between prison guards and police/firefighters will be addressed elsewhere and later.

Guards have a list of duties, and through either a dynamic or static security process they also present an opportunity to be a positive part of the correctional program, a resource that seems to be overlooked. The uniform guards wear identifies them as officers with Correctional Service of Canada, an agency of the federal government, whose purpose is to serve the people. Because prison inmates have more contacts with guards than other CSC employees, they are front-line representatives of the society to which almost all inmates will one day return.

Understandably, guards do not bring their mobile technology into the workplace. They are a potential risk, and a distraction too which is why televisions are also prohibited in the towers and bubbles. Despite that long duty list, there are periods where overseeing their charges can tax alertness and is it here that part of the job description, “supervise and interact with offenders,” takes on a greater significance. It is here that guards can play a positive role in helping inmates complete their correctional plans.

Something to be considered.

…….still more soon.

Toronto South Detention Centre……

……to be fair, we got an answer.

“About 200 Toronto South Detention Centre guards refused non-essential work at the jail on Monday, March 4, after an alleged assault by inmates injured eight staff members on the previous weekend.”

So began the April 21st posting reprinting our letter to the provincial minister, critical of the bias with the department’s reporting of operational issues at this Toronto jail. Despite so much evidence to the contrary, government, guards and their union cite inmate hostility as a central cause of the problems at the institution….along with ongoing complaints by guards of staffing shortages.

As the media reported later, that weekend attack on guards was precipitated by an earlier assault by guards on an inmate. Unjustified use of force by either side isn’t sanctioned in principle, but it’s notable that officially, guards don’t attack inmates.

The March 15 letter to Minister Sylvia Jones pointed out that “no inmate who is not deranged awakes of a morning and decides to assault a guard….. Are you aware of the consequences?” A second letter followed on May 6 asking for a comment when there was no response. “I Hate Inmates!” posted on May 19 implied an answer was doubtful.

Unexpectedly, a lengthy June 19 letter over the minister’s signature addressed the issues raised, and with an unusually candid and liberal bent for a Conservative cabinet minister. “We are creating better housing options, redefining segregation…..better mental health screening and assessment tools.” “We have implemented measure to provide better oversight and support…..” “At Toronto South Detention Centre, steps are being taken to improve staff and inmate safety…..” At TSDC, “a new initiative…..will address key challenges…for improvement through a formal culture audit.” “Overcrowding is a key issue….hiring remains a top priority….to meet existing shortages, reduce lockdowns, ease workloads…..”

There was more in the same vein, not anticipated from a minister of a political party more attuned to a let-them-rot-in-hell scenario for imprisoned offenders. But, Minister Jones’ letter ended with, “Your feedback is important and will help our government inform its policies.”

“Policies.” Therein lies the hidden juggernaut waiting in the shadows. No minister of any party, no head office bureaucracy, no amount of input from outside the system has ever been able to successfully address the difference between policy, and practice in the trenches.

MORE LIGHT SWITCHES IN OUR FEDERAL PRISON INDUSTRY WILL CONTINUE NEXT WEEK………

A light switch #1…….

…..it’s a start!

A Culture: There are two criteria which must be met for actions to be considered part of the culture of an organization. The actions must be widespread in the organization, and they must be persistent.

‘Widespread’ assumes that the actions often occur in the organization – not all the time, but with considerable frequency so that when they do take place no one thinks twice about them, they just say, yes, that’s the way things work here. Not everyone has to take these actions, but those who don’t, realize there’s not much they can do about them. The actions are frequent enough that there’s no thought of penalizing or criticizing the actors, and there’s no allegations that the actors are ‘bad apples.’

‘Persistent’ means the actions continue over a relatively long period of time, usually measured in terms of years.

If deviant actions are widespread and persistent, it is fair to conclude that those deviant actions are part of the culture of the organization. They define the way the organization functions.

….from Toronto Police Accountability Bulletin No. 114, June 25, 2019
info@tpac.ca

A Reality: Referencing Lee Chapelle of Canadian Prison Consulting once more, about 20% of inmates in federal institutions are incorrigible according to his estimate. These men and women can’t be reached, and aren’t motivated to be more than they are. All the same, these few are protected by the same laws and policies as other prisoners, (“Inmates are Clients”….June 2), and pathways to a future must be among their available options.

The majority of inmates present viable opportunities for CSC to exercise its correctional mandate. This is not a homogeneous one-size-fits-all group though, and tailored programming targeting specific needs are more likely than not to be better received and potentially offer the most positive outcomes.

continued…..

Lights, lights, lights!

Who can see in the dark?

Correctional Service of Canada is charged with safely returning offenders to the street as responsible, law-abiding citizens. Observation says it can do better. Over the last few years, and most notably, the Canadian Civil Liberties Association, the John Howard Society, the British Columbia Civil Liberties Association, the Elizabeth Fry Society, as well as print/broadcast media, and along with provincial and federal courts have worked to redirect CSC policy and practice, in particular referencing solitary confinement.

Our federal prison system has an extensive and experienced bureaucracy capable of trending towards the most progressive principles, formulas and programs to meet its mandate. It should lead the way, rather than reacting to outside opinions that appear better informed. Why do our courts have to order CSC to overcome its reluctance to change? Why does CSC then twist itself into knots trying to comply with court decisions on the one hand while angling to end up in the same place its always been on the other?

We have a government that continues to kowtow to CSC ‘traditionalists’ and intervene on behalf of the Agency to stifle proposed changes to policies governing solitary confinement for example and restrict or eliminate independent and non-governmental monitoring of policy practice. And then there’s the release this month of the West Coast Prison Justice Society’s report, “Damage Control: Use of Force and the Cycle of Violence and Trauma in BC’s Federal and Provincial Prisons.” It underscores how use of force in our prisons more often exacerbates “an adversarial environment that compromises safety and wellbeing for both prisoners and staff.” Yet, Correctional Service of Canada isn’t prepared to fully embrace progressive and tested alternatives.

Attempts to encourage accountability and transparency beyond the walls and razor wire is a difficult and frustrating exercise. For the sake of the community at large, it’s a trial the’ villages’ from which our prisoners sprang need to play as much a role as the activists and advocates who point the way.

More to come…..

NOTE: APOLOGIES. IT’S BEEN THREE WEEKS SINCE THE LAST POSTING. UNNECESSARY DISTRACTIONS INTERFERED WITH PRODUCTION.

 

INMATES are CLIENTS…….

…….not fodder for the maw of our prisons.

Okay, a qualifier first. Perfection is a goal, not an expectation, and what we call our correctional services can’t bear sole responsibility for reshaping society. It takes a village to raise a child? Villages criminalize children too, indoctrinated more by neglect and abuse than intent. And when those children later end up in our justice and carceral systems, villages consign them to prisons with “fix ‘em”…..or, “keep ‘em ‘til they’re fixed.” Or maybe, just “keep ‘em.” Sorry folks, it doesn’t work that way.

There are some bad people in our prisons, people who should never see the inside of a Tim Hortons again, or shop for groceries or buy a case of beer. And, even if the mess inside their heads is unscrambled and they are choking on a glut of remorse, some crimes are so heinous only God can forgive. All the same, these few are protected by the same laws and policies as other prisoners and must have opportunities to build a life inside the walls, to be free of cruel and unusual punishment, to be treated humanely and held safely, and in the end, to die with dignity. Otherwise, we make ourselves less than human.

Prison practice must match policy. Prison practice must follow the law. That this is often not in evidence is as much the responsibility of the villages that send men and women to prison as it is the obligation of the keepers of these men and women. The very few who will live their entire lives in custody are as entitled to fair practice as the great majority who will one day return to the community. In particular, since almost all our prison population will one day be released, the only question of note is, “Who do you want your new neighbours to be?”

Offenders are sent to prison as punishment and not for punishment, to parrot Correctional Investigator Ivan Zinger. Lee Chapelle of Canadian Prison Consulting begins presentations on the realities of a prison sentence by reminding his audience that people do not comprehend how traumatic the loss of freedom can be. Living in a cell the size of an average bathroom, in an environment charged with risk, and under the thumb of public servants whose priorities are not always rehabilitative is a challenge difficult to master.

So, how do we make a prison industry into a correctional service, and why is community involvement important to good governance?

More next time……

 

“I HATE INMATES!…….

…..WHO DO I OWE A BEATING TO TODAY?”

This rant by a guard walking onto a range a few years ago at the defunct Toronto West Detention Centre is one variation of a mantra endemic in Canada’s prison industry. Only inmates, the source of this guard’s livelihood, and other staff members were within earshot, and this guard was intentionally threatening and intimidating, daring a challenge, and looking for any excuse to assault an inmate.

“Hate” and “beating” were words expected to incite contempt by inmates for a system that is mandated to positively redirect future decisions but instead is primarily correctional in name only. In the end, recidivism is a key component in maintaining a stable work environment for everyone employed in the business. Most job actions directed at sustainability in provincial and federal institutions are less obvious than that guard in Toronto West years ago, they’re frequently passive, and may even appear benign, but are equally effective, nonetheless.

Provincial jails house men and women convicted of an offence and sentenced for relatively short periods, but often a majority of inmates are held on remand, awaiting the disposition of charges. For these, the vegetative wait for technically innocent people can stretch into years, two, three or even four. An inadequate bail program, insufficient public resources, underfunded legal aid support, backlogged court dockets, and a lack of political will keeps many in custody who otherwise could benefit from opportunities in the community.

There is little work, few programs, a phone system allowing only collect calls, and no direct contact with family/community support. Worse, there’s a move away from visits where barriers separate inmates and people from the outside to ‘video visits’, where both parties see only the head and shoulders of one another on a monitor and communicate over a phone. To boot, there’s no dedicated resource for inmates to air concerns, and what little is available is of no consequence to provincial jail staff or management. How bad can it get?

“Toronto South…..again!”, posted April 21st examples how a lack of accountability enables contempt of both prisoners and their keepers for ministry policies, and even the law. Jails are laboratories developing the building blocks of an industry’s foundation. We followed up our March 15th letter to the Ontario minister with a May 6th request for comment. Bets?

More looks under the rock coming……