Anne Tolley ratchets up the screws on prisoners.

Section 5 of the Corrections Act requires that prisons are “operated in accordance with rules …  that are based on the United Nations Standard Minimum Rules for the Treatment of Prisoners.” However, in its report titled “Investigation of the Department of Corrections in relation to the Access and Availability of Prisoner Health Services”, the Ombudsman found numerous failings in the delivery of health services.  He also said the Corrections Department does not meet Article 22(1) of the UN Minimum Standard Rules – which requires every prison to have at least one qualified medical officer, who should also have some knowledge of psychiatry.

Mental torture

This rule appears to be breached by virtually every prison in the country. The Ombudsman found that “Many medical officers have limited training in psychiatry and… some prison healthcare teams had no mental health nurses to provide specialised care to those who fell beneath the threshold of severe and enduring illness.”

To put it bluntly – this is crazy.  More than half of prisoners have had mental health problems; 60% have a personality disorder; almost two thirds have had a serious head injury and 90% have a history of alcohol and drug abuse. But the level of psychiatric care in prison is minimal. In an interview with psychiatrist and Parole Board member, Dr Phillip Brinded, the Sunday Star Times reported that “If a prisoner is so psychotic they can’t be managed, they will join the ‘acute’ list and get to hospital within days, but those who are just quietly off their rocker can languish on the ‘sub-acute’ list for many months. It seems that in order to get treatment in prison, you have to go really mad.”

Dental torture

This is not the only UN Rule breached by the Corrections Department. For instance, Article 22 (3) states that “The services of a qualified dental officer shall be available to every prisoner.” That sounds reasonable.  Prisoners tend to have chronically poor oral health care and the Prisoner Health Survey (2005) found that one third of those interviewed reported having a toothache in the previous month.  However, Corrections has difficulty securing the services of dentists – presumably because the Department doesn’t pay dentists as much as they can earn in private practice. Because of recruitment difficulties, the Ombudsman reported that the Department has been flying a dentist from Wellington to Christchurch to provide dental care for prisoners at all three Canterbury prisons.

Even in those prisons where dentists are available, the waiting list is up to three months. But here’s the real toothache.  The Department has a “minimum dental services policy” whereby pain relief only is provided to most prisoners – which may include medication, extraction, or drainage of an abscess.  Early treatment with amalgam fillings – which would prevent further decay – is not provided. Now that’s really crazy.

But the pain gets worse. Prisoners near the end of their sentence are not eligible for any dental treatment at all – they just get medication. The Ombudsman gave case histories of prisoners who had severe tooth decay who were not allowed by prison nurses to even see the dentist. For some of these prisoners, the decay eventually turned into an abscess.  One prisoner reported that “his jaw ached, his glands were swollen, and he had a sore ear – and he couldn’t sleep.”  All he got was panadol and told to “see a dentist when you get out.” That may not be torture – but it sure as hell hurts – night and day – for months on end.

Lets ratchet up the screws

The Ombudsman concluded his report with a recommendation that responsibility for the health care of prisoners should be removed from the Corrections Department entirely and given to the Ministry of Health. The MOH agrees. A study released by the Ministry in 2010 says “An inherent tension exists between a custodial role and the delivery of comprehensive, high quality health services… current institutional arrangements prevent medical professionals from fully exercising their duty of care.”

Corrections Minister, Anne Tolley, and chief executive, Ray Smith, are clearly unconcerned. They want to reduce, rather than increase, the role of medical professionals in prison. Legislation was introduced to Parliament in February giving nurses rather than medical officers (doctors) overall responsibility for the healthcare of prisoners.  Up till now, Medical Officers who are contracted to Corrections have been responsible. Being on contract, they have some independence and can make decisions based on ‘best practice’.  But prison nurses are employees not contractors  - they can be told what to do by prison managers who have no medical training whatsoever.

This legislation will increase the ‘inherent tension’ which already exists and further erode the standard of medical care in prison.  Some would say – but they’re all crims in there, so who cares?  No one in the Corrections Department, that’s for sure.  Their attitude seems to be – if we can’t torture them, let’s make sure they feel the pain.