Three former prison doctors call for inquiry into prison health services

Three former prison doctors have called for an inquiry into prison health care. This is the full transcript of an interview with the three doctors broadcast on Radio New Zealand's Morning Report on 1 October 2013.

Geoff Robinson: A former Otago prison doctor who is critical of the way health services are provided in prison says a major review is needed. Last week, Radio New Zealand revealed that the police are investigating allegations that a prisoner received substandard care at the Otago prison before he died in February 2011. They’re also reviewing another prisoner’s suicide four months earlier. Dr Wayne Cunningham says prison administrators are experts in security and not health, and something has to change. Here’s our Otago reporter, Ian Telfer:

Ian Telfer: Wayne Cunningham’s a GP who teaches at the Otago University Medical School. He took a part-time contract as prison doctor at the Otago Corrections Facility near Milton on the day it opened in 2007. Dr Cunningham said he’d never done the job before and had to wise up quickly to the prisoners and the prison service. But he says he and another doctor gave up their contracts after three years in 2010 because it was getting too risky.

Dr Cunningham: "The most confronting stuff is around detoxification, where prisoners would come in, especially alcoholics, who were sometimes consuming enormous amount of alcohol (before they came to prison). They need to detox – but facilities to detox safely in prison are very limited, well, they were certainly limited when we were working there.”

Ian Telfer: “And you were concerned people could die?”

Dr Cunningham: “Absolutely. There were some occasions when it was almost miraculous that nobody died while we were looking after them.”

Ian Telfer: The two deaths under police investigation happened just a few months after Dr Cunningham left the prison - one a suicide and the other involving drugs. Dr Cunningham says when he was at the prison, there was no facility to provide nursing care right through the night as would happen in hospital. He said there were times when the level of care was not the same as that provided in the general community. Dr Cunningham says in Britain, prisoner care was shifted to the Health Ministry about a decade ago - and it is time for a major review to look at doing the same thing in New Zealand.

Dr Cunningham: “The Department of Corrections has expertise in the management of custody. The Ministry of Health has expertise in the delivery of health care. I think that’s the organisation which should have responsibility for delivering health care in prisons.”

Ian Telfer: Dr Cunningham's colleague at Otago prison was Dr Richard Simpson. Dr Simpson says they felt they worked for Corrections first and as doctors second - and that meant they could not always carry out ‘best practice’.

A former prison doctor who worked at three Christchurch jails for several years, but won’t be identified, is backing the call for a review. He says he left the prisons after unsuccessfully pushing for a national clinical director position to bring in more medical expertise and reduce the isolation and risks for (prison) doctors.

Unidentified Christchurch prison doctor: “Medico-legally, prisons are quite a risky place to work and so the longer you work there, the more likely you are going to end up in front of the health and disability commission or a coroner's Court. It is a very fatiguing kind of job and, to do it day in and day out, you just cannot do it forever.”

Ian Telfer: But the Corrections Department says there is no problem with the health service that needs fixing. Its Director of Offender Health, Bromwyn Donaldson, said the service looks after thousands of inmates. She says events like the two deaths at Otago prison are upsetting - but are not typical and are being taken out of context.

Bronwyn Donaldson: "We have a lot of policies and procedures; we have the Cornerstone accreditation process which looks at those policies and procedures; we have audits of the health services delivered; we have complaint mechanisms, and customer satisfaction surveys. All the evidence I have in front of me gives me no cause for concern.”

Ian Telfer: Bronwyn Donaldson says there are many agencies watching prisoner health and it already gets enough scrutiny.

Geoff Robinson: Corrections Minister, Anne Tolley, declined our interview request but gave us this statement which said: “Corrections has a duty of care to prisoners which it takes very seriously. Staff always have to be mindful of safety and security; they are often dealing with high risk and high security prisoners.”