Torture in New Zealand 3 – prison doctors forced to breach medical ethics

In 2009 Dr Michael Roguski and Fleur Chauvel released a report titled The Effects of Imprisonment on Inmates and their Families Health and Wellbeing.  They interviewed 63 New Zealand inmates about their medical treatment in prison and provided a number of case studies. Here’s one about a male prisoner who had been prescribed anti-anxiety and anti-depression medication for a number of years prior to coming to prison. While in the community, he had monthly appointments with his GP and saw his psychiatrist every six months.  The prisoner wrote:

“When I arrived at the prison they removed all my antidepressants. They said that I might be stood over for them. I was unable to sleep so after about a week they gave me antihistamines. It didn’t really help… I was too anxious. I was not sleeping for days on end. I was at maximum despair. I could feel myself going downhill in this negative environment. 

“After about a month they gave me a different antidepressant from the one I was on on the outside. But it was a really low dose and things didn’t improve. Another two months went by. I was in agony and I was put in At Risk as I’d started spinning out. I couldn’t see any way out. A week after going to At Risk the doctor came and visited me and he prescribed the same meds I was on on the outside. Yeah, it was a real bad time. I was in agony.” (Richard, Pākehā, 40–50 years)

Medical malpractice

At best, this is medical malpractice.  At worst, its torture.  New Zealanders who commit a crime and end up in prison are entitled to the same level of healthcare and quality in treatment they would receive if they remained in the community.  This is specified in Section 75 of the Corrections Act 2004 which states:

“A prisoner is entitled to receive medical treatment that is reasonably necessary” and “the standard of healthcare that is available to prisoners in a prison must be reasonably equivalent to the standard of healthcare available to the public”.

This requirement is reinforced by Regulation 73 of the Corrections Amendment Regulations 2013 which describes the ‘Duties of a Health Centre Manager’ (the head nurse) as follows:

“The health centre manager of a prison must take all practicable steps to maintain the physical and mental health of prisoners to a satisfactory standard… and must “ensure that medicine is administered to a prisoner in accordance with his or her medical needs”.

Corrections’ Medicines Policy

However, the Corrections Department largely ignores these statutory requirements by making up a prison ‘Medicines Policy’ which, in effect, tells doctors and nurses to ignore their nursing and medical ethics.  For instance, paragraph 6.1.1 of the Medicines Policy tells doctors that:

“Prescribing medication that can be misused/abused or has some economic value in a prison environment (or example benzodiazepines, opioids, zopiclone) is actively discouraged. A clinically suitable alternative medication or treatment option is preferred.”

The systematic denial of opiates and other clinically appropriate medication is discussed in Torture in New Zealand 2 – forcing prisoners into withdrawal. It causes serious distress to the prisoner without leaving any visible evidence of the harm and suffering it causes.  And, it is incompatible with the legislation described above.  It also appears to breach Section 151 of the Crimes Act which requires anyone:

“who has actual care or charge of a person who is a vulnerable adult to  provide that person with necessaries; and to take reasonable steps to protect that person from injury”.

Although caution has to be taken when prescribing potentially addictive medication, members of the public are not generally denied opiates, or mental health medications, just because they are open to abuse or potentially tradable. But prisoners are.  This ‘discouraged medication’ policy negates any possibility that prisoners can receive an equivalent level of care to patients in the community.

The Medical Code of Ethics

In addition to potential breaches of human rights, the Crimes Act and the Corrections Act, the denial of medication to prisoners is also incompatible with doctors’ medical ethics. For instance, the New Zealand Medical Code of Ethics contains 12 Principles and 44 Professional Responsibilities.

The first principle is:

“Consider the health and well-being of the patient to be your first priority.” 

If doctors fail to prescribe clinically appropriate medication because of the Department’s concern that medicines may be traded, then rules established by prison management have become the doctor’s first priority – not the well-being of the patient.

Recommendation number 7 states:

“When a patient is accepted for care, doctors should render medical service to that person without discrimination (as defined by the Human Rights Act).”

When prisoners in severe pain or with mental health problems are not allowed certain medication simply because they are in prison, that constitutes discrimination.

Professional responsibility number 37 states:

“Doctors should not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman, or degrading procedures, whatever the offence of which the victim of such procedures is suspected, accused or guilty.”

Denying appropriate painkilling medication to patients in severe pain; or removing anti-psychotic and anti-depressant medication from prisoners who need it is inherently cruel and inhuman. Doctors are responsible for their own clinical practice, but the problem ultimately lies with the Department’s ‘discouraged medication’ policy – and the punitive culture which surrounds it. It seems doctors who follow this policy are unwittingly performing enhanced pharmacological torture on physically and psychologically vulnerable prisoners – in the process, they are completely ignoring their medical ethics.