BC College of Physicians and Surgeons must address ethical issues surrounding solitary confinement
August 14, 2018 – Burnaby BC – Prisoners’ Legal Services
On August 9, 2018, the Health Professions Review Board issued an important decision requiring the BC College of Physicians and Surgeons to directly confront the issue of medical professionals’ ethical duties under the United Nations’ Standard Minimum Rules for the Treatment of Prisoners (the Mandela Rules) related to solitary confinement.
Brent Crane, a prisoner who was held in long-term solitary confinement at a BC Corrections pretrial centre, brought a complaint to the College that alleged a psychiatrist violated professional standards when she failed to consider the Mandela Rules in her treatment of him. Mr. Crane argued that the Mandela Rules gave expression to the Canadian Medical Association’s Code of Ethics duty to “refuse to participate in or support practices that violate basic human rights”.
Mr. Crane is an Indigenous prisoner. His mother was in residential school and he experienced violence as a child. He has been diagnosed with schizophrenia and major depression with anxiety. His medical records also indicate that he likely suffers from Fetal Alcohol Spectrum Disorder.
The Mandela Rules prohibit solitary confinement for prisoners with mental disabilities when their condition would be exacerbated by its use, and for anyone for more than 15 days, as this is considered to be torture or cruel treatment. The Mandela Rules require physicians not to participate actively or passively in torture or cruel treatment, to report a prisoner’s physical or mental deterioration in solitary confinement to the prison warden and to the competent authority, and to advise the warden if the physician considers it necessary to terminate solitary confinement.
Mr. Crane’s medical records contained multiple notations from other medical professionals that he was exhibiting symptoms associated with long-term solitary confinement, including anxiety, depression, anger, cognitive disturbances, perceptual distortions, paranoia and psychosis.
“I don’t feel well in solitary confinement,” said Mr. Crane in his affidavit. “I don’t have anything. I’m by myself in isolation…I feel trapped,” he reports.
The complaint alleged that the psychiatrist participated in Mr. Crane’s solitary confinement by cancelling his certification, which would have allowed him to move from solitary confinement to a psychiatric hospital, by failing to report his mental health deterioration to anyone, and by failing to document the negative psychological effects of prolonged solitary confinement on him.
“Medical professionals who work in prisons may become coopted by the security-focussed perspective of correctional officers. We are hopeful that this decision will empower medical professionals to advocate for the wellbeing of their patients who are in solitary confinement,” said Jennifer Metcalfe executive director of Prisoners’ Legal Services.
“The majority of prisoners who are held in solitary confinement suffer from mental disabilities and have a history of trauma and addiction. These are the people most in need of compassionate treatment by medical professionals. These prisoners need therapeutic services and environments to heal so that they can succeed when they are returned to the community,” she said.
In Mr. Crane’s case, the College dismissed his complaint and its Inquiry Committee found the psychiatrist’s conduct and competence satisfactory.
The Health Professions Review found that the Inquiry Committee “failed to confront the key issues” of the application of the Mandela Rules. It found that “the fact that the Inquiry Committee’s findings might have wider systemic implications did not diminish that duty” to “confront the issues of professional responsibility concerning the protection of ‘basic human rights’”.
The psychiatrist in this case argued that a finding could not have been made against her by the College’s Inquiry Committee unless she “was aware of and shared the view that his human rights were being violated”. The Health Professions Review Board questioned whether this was the appropriate test for compliance with professional standards, noting: “In order for the Inquiry Committee to accept the position of the Registrant…it would have to accept that the Mandela Rules, and torture as defined therein, are only applicable where a treating physician agrees with them”.
When the Mandela Rules came into effect in 2015, Prisoners’ Legal Services wrote to the BC College of Physicians and Surgeons requesting that they issue guidelines about them for their members who work with prisoners. The College responded saying that it would not issue such guidelines, but would investigate any complaints regarding the care provided by their members to prisoners.
The Health Professions Review Board decision suggests that the College should revisit the idea of issuing standards or guidelines in relation to the application of the Mandela Rules to physicians working with prisoners.
“Prisoners’ Legal Services would be happy to assist the College to develop guidelines for its members to ensure they are acting in the best interests of their patients, and not participating in their torture or cruel treatment”, said Metcalfe.
“I am glad that my case can help other people who are in solitary confinement,” said Mr. Crane. “I don’t want anyone to feel sorry for me. I just want my case to help other people.”
Click here to read the Health Professions Review Board decision in this case.
Prisoners’ Legal Services