PLS on BC Corrections: Health Care
On Thursday, January 16, 2014, Prisoners’ Legal Services participated in a roundtable discussion regarding the safety of staff, prisoners and the community in BC, hosted by MLA Thrones, the Parliamentary Secretary to the Minister of Justice and Attorney General for BC Corrections.Our letter to Mr. Throness outlines the issues that Prisoners’ Legal Services has identified in relation to BC Corrections, including our recommendations for improving safety.
This post is the third of four excerpts from our letter to Mr. Throness, on the provision of health services in BC prisons.
3. Health Care
(a) Legislation, Policy and Case Law
Subsection 2(1)(h) of the Correction Act Regulation provides that the person in charge of the institution must ensure that prisoners are given access to health care.
The BC Corrections Branch Adult Custody Policy Manual and the Health Care Services Manual set out the health services that must be provided to provincial prisoners (see Eshghabadi v. British Columbia (Minister of Public Safety and Solicitor General), 2011 BCSC 434 at ¶ 59).
Health services are contracted out by the Ministry of Justice to Sentry Correctional Health Services Inc. (“Sentry”), a private contractor.
(b) Literature Review
On December 20, 2013, Dr. Ruth Elwood Martin, of the Collaborating Centre for Prison Health and Education, provided the Deputy Minister of Health with her recommendation to transfer delivery of health care for provincial prisoners from the Ministry of Justice to the Ministry of Health, with the Regional Health Authorities assuming responsibility for delivery of correctional health care.
Dr. Martin notes that an estimated 50-70% of prisoners in BC have hepatitis C, 10% of women prisoners in BC have HIV and that prison staff estimate that 80% of prisoners have a substance abuse disorder. She refers to a study that indicates 26% of BC prisoners have a mental disorder unrelated to substance use.
Dr. Martin raises concerns regarding the delivery of health services by a private contractor as it does not allow for continuity of care for individuals who are regularly in and out of custody. For example, she notes that family physicians do not receive discharge summaries from the provincial correctional health system.
Dr. Martin refers to international recognition in leading medical journals that continuity of care from the community, to prison, and back to the community, is essential to improve the health care of prisoners. She notes that the World Health Organization recommends that prison health care be aligned with a country’s public health and primary care services for the general population. Dr. Martin reports that Norway, the United Kingdom, France and New South Wales in Australia have all transferred health care provision for prisoners to their Ministries of Health. In Canada, Nova Scotia and Alberta administer prison health care through the Ministry of Health.
The benefits of the Ministry of Health administering provincial prison health care noted by Dr. Martin include reduced recidivism rates, more consistent treatment of TB, HIV, Hepatitis C and STDs, shared immunization records between BC Corrections and health authorities, and family physicians having access to records, thereby improving patient safety.
A recent study by the BC Centre for Excellence in HIV/AIDS has found that incarceration is a strong predictor of inadequate treatment for HIV/AIDS and that people with HIV are more likely to share needles in prison. The study found that when people are incarcerated, viral loads were higher due to inadequate HIV treatment. Because there is no needle exchange program in prison, people who use injection drugs are more likely to share needles while in prison. Sharing needles while viral loads are high is very dangerous. The study calls on prison administrators to implement harm reduction strategies such as needle exchange programs and to improve access to HIV treatment in prison in order to reduce the rates of HIV transmission among prisoners and in the community.
On December 16, 2013, Madam Justice Ross of the BC Supreme Court issued her decision in Inglis v. British Columbia (Minister of Public Safety), 2013 BCSC 2309 (“Inglis”), which was a challenge to the decision to cancel the mother-baby program at the Alouette Correctional Centre for Women. The facts regarding the health benefits of mothers and babies being together were not contentious. The respondents agreed with the applicants that:
- It is best practice for mother and baby to be together in the immediate post-partum period for the health and social benefit of mother and baby. This contact is critical for the development of mother-baby relations and for the promotion of parental capacity.
- International health experts agree that babies should be breastfed exclusively until six months of age and that they should continue to breastfeed on demand until the age of two. Breastfeeding benefits the baby’s health and psychosocial development and lowers the risk of ovarian cancer, Type II diabetes and post-partum depression in mothers.
- The critical period for the formation of attachment of a baby to his or her primary caregiver is six months to two years. Attachment assists with the baby’s psychological and social functioning and is necessary for normal neurobiological function. Attachment is related to the ability to form future intimate relationships, to be emotionally balanced, to be happy and to be able to rebound from disappointment. Interfering with attachment puts the baby at risk of lifelong developmental deficits, insecurity and feelings of neglect. Adults who had problems with attachment as babies often experience difficulties understanding their own emotions and the emotions of others, and have an impaired ability to maintain relationships.
- Mothers who are separated from their babies may experience depression, suicidal ideation, increased use of alcohol and drugs, and increased criminal activity.
(Inglis at ¶328-335.)
Justice Ross finds that BC Corrections’ cancellation of the mother-baby program violated the rights to security of the person and liberty under s. 7 and the right to equality under s. 15 of the Charter. She finds that the decision was not based on a reasonable apprehension of potential harm to babies, or on cost considerations. She finds that BC Corrections adopted a guarantee of safety as the standard, which was impossible to meet and inappropriate in light of the constitutional issues at play in the decision.
The Court considers international human rights documents that stand for the proposition that a state’s responsibilities should be “in keeping with its fundamental responsibilities for promoting the well-being and development of all members of society”, which includes the concept of the best interest of the child. Justice Ross concludes that BC cannot be permitted to avoid its obligations to protect the best interest of the child under the Child, Family and Community Service Act, RSBC 1996, c. 46, by compartmentalizing duties under different ministries and legislation.
(c) Observations of Prisoners’ Legal Services
Prisoners’ Legal Services has received many calls from BC prisoners who report that they have been cut off their medication when brought into custody. This practice appears to be contrary to policy which requires that measures be taken to ensure a continuum of care for prisoners at intake.
Many of our clients report that when they arrive at a provincial prison, they are taken off community prescribed medication for conditions including depression, Attention Deficit Hyperactive Disorder, Bipolar Disorder and HIV/AIDS. Our clients report that they are taken off their medication before seeing a doctor, and they are not informed of the decision or reason for the decision to discontinue medication. When they do see the institutional doctor, they are less likely to be put back on medication that they felt was effective in the community.
Discontinuation of medication can have very serious consequences for our clients. In the case of HIV medication, interruptions in anti-retrovirals can result in spikes in viral loads that can cause serious medical complications and symptoms of AIDS. Prisoners who have been cut off mental health medications often report difficulties in controlling their behaviour resulting in repeated charges for disciplinary offences. These charges result in segregation which can exacerbate the mental illness.
Prisoners’ Legal Services has also received reports from prisoners that the institutions have stopped providing prisoners with over the counter medication. Prisoners who cannot afford to purchase over the counter medication are forced to attempt to obtain medication, such as Tylenol, by other means. This often results in prisoners trading items or favours for medication from other prisoners, which can lead to safety concerns and disciplinary charges.
Prisoners complain that they do not receive timely responses to requests for health care appointments.
Prisoners’ Legal Services often has difficulty receiving medical information from the health care departments of the institutions. Health care departments will deny our clients the right to legal assistance by refusing to provide medical documentation despite being provided with signed consent for the release of the information.
Our office receives numerous complaints regarding specific doctors under contract with Sentry. Prisoners’ Legal Services will assist our clients to make complaints regarding the doctor to the College of Physicians and Surgeons and the BC Investigation and Standards Office. The BC Minister of Justice’s contract with Sentry requires that Sentry “perform the Services to the reasonable satisfaction of the Assistant Deputy Minister”. Despite numerous complaints, nothing has been done to improve the quality of medical services provided by Sentry.
When a prisoner has filed a complaint with the College of Physicians and Surgeons or the Investigation and Standards Office against a doctor, they are not always able to see another doctor while the complaint is active. This may mean that the prisoner is denied health services.
Contracting out medical services makes it impossible for BC Corrections to perform quality assurance and to ensure that health services in prison are equivalent to community standards. It also prevents BC Corrections from setting standards for health care professionals such as requiring certification with the College of Family Physicians of Canada which would require doctors to participate in annual continuing professional development. Certification with the College of Family Physicians would also allow doctors to become clinical instructors and increase collaboration with the University of British Columbia, which would have the effect of improving the quality of health services provided to BC prisoners.
Prisoners’ Legal Services makes the following recommendations regarding the provision of health services in BC provincial prisons:
1) That the Minister of Justice transfer the provision of health services to the Ministry of Health with the Regional Health Authorities delivering health care to provincial prisoners.
2) That doctors who provide health services within BC Corrections facilities be required to be certified with the College of Family Physicians of Canada.
3) That BC Corrections implement harm reduction strategies in all BC prisons including needle exchange programs.
4) That BC Corrections reinstate the mother-baby program at the Alouette Correctional Centre for Women and that the Ministry of Justice not appeal the Inglis decision.
5) That a nurse be scheduled to be on staff at each institution 24 hours per day, seven days per week.
6) That an alternative doctor be made available to see a patient who has made a complaint regarding the regular institutional doctor.
7) That policies regarding ensuring continuum of care for prisoners entering and leaving provincial custody are adhered to.
8) That clear policy be implemented to ensure that medical treatment is not terminated except by a physician who has met with the patient.
9) That policy be implemented to require that responses to health care requests are delivered without delay to patients, and that a patient’s medical information is shared with him or her, or his legal counsel, upon request.
10) That over the counter medication that is deemed medically appropriate is provided to prisoners from the health care department, free of charge.