Prison suicides swept under the Cornerstone

The suicide rate in New Zealand prisons is eleven times higher than in the general population – and since 2008, more than 75 prisoners have died . This self-destructive slaughter has much to do with high rates of mental health problems combined with poor quality psychiatric care in prison. Doctors and nurses who treat prisoners are simply unable to provide an equivalent level of care to that received by patients in the community. In 2011, the Ombudsman called this a “serious concern” and recommended responsibility for healthcare of prisoners should be removed from the Corrections Department and given to district health boards.

Prison managers don’t like that idea as it might lead to a small loss of control over their caged in kingdom. The Department would rather paper over the cracks by having its 19 prison health centres awarded Cornerstone accreditation. Cornerstone is a seal of approval granted by the Royal New Zealand College of General Practitioners to health and medical centres that meet a defined set of standards called Aiming for Excellence – standard for New Zealand general practice.”

The standards for ‘general practice’

In order to meet the standards, a health centre first has to meet the definition of “general practice”. The RNZCGP has 12 criteria which define general practice. The first is that the centre must provide “personal, family and community oriented comprehensive primary care…” That should rule out every prison health centre in the country – since none of them are ‘family or community oriented’. The treatment is not exactly ‘personal’ either – which medication prisoners receive is dictated by Corrections’ Medicines Policy which states that doctors are ‘discouraged’ from prescribing opiate pain killers (like morphine and tramadol), anti-anxiety medications (such as valium), sleeping pills like zopiclone and mood stabilisers like ritalin – because these are  considered drugs of abuse.

The second criterion is that the health centre must provide ‘open and unlimited access to its users…”  That should also exclude every prison health centre – since prisoners don’t have open and unlimited access to anything.   Despite the fact that prison health centres do not appear to meet any of the criteria for a ‘general practice’, five prisons in the country have been granted Cornerstone accreditation. What’s more, Corrections is aiming to have all 19 prison health centres in the country accredited in the next two and a half years.

Suicides at Otago prison

The health centre in Otago Corrections Facility (OCF) is one of the five. How did that happen when the Department’s own ranking system puts  Otago prison at the bottom of its’ performance ratings.  Health care in Otago prison is so poor that about two years ago, two prisoners died within three months of each other.  Richard Barriball was a victim of Corrections ‘discouraged’ medication policy; they took away his methadone, his tramadol and his diazepam.  In severe pain from a serious arm injury, he committed suicide a week later. The coroner said the prison  failed “to provide delivery of prescribed pain relief” and that Mr Barriball received “sub optimal care”.

Jai Davis died in OCF in February 2011.  He came in over the weekend – when the prison doctor was off duty – suspected of ‘internally concealing’ drugs.  He should have been taken directly to hospital to be examined, x-rayed, and monitored. Instead, he was taken to OCF which is 45 minutes’ drive from the nearest hospital. He was placed in the at risk unit where he was supposed to be observed every 15 minutes. No one bothered to call the doctor – the nurses just ignored him and he died two days later.

These deaths were described as suicides, so at the time, police never bothered to investigate. Soon afterwards, the Otago Daily Times reported that the health centre at the prison was given Cornerstone accreditation.  Prison nurse Jan Horne was quoted in the story saying that accreditation “put the health centre and the staff on par with other medical centres around the country”.  Yeah right! But  that’s Corrections plan for suicides in prison – get the RNZCGP to rubber stamp the process and hide the bodies under Cornerstone accreditation.

The process of accreditation

Why does the RNZCGP collude with the Corrections Department in this cover up?  I contacted the College and asked how the accreditation process works.  I was told that when the College evaluates a prison health service, no one actually talks to any prisoners; no one asks whether they are satisfied with the service; no one finds out how many complaints have been made; no one contacts the Health and Disability Commission to find out if any complaints have been investigated; no one contacts the Ombudsman to see if prisoners complain about health care more than any other aspect of prison life; no one even asks if any prisoners being treated by the prison health centre have died recently.

But there is a process – prisoners can make a written complaint. Great – except that 90% of prisoners can barely read and write.  And there is a box to put the complaints into.   Great – provided the nurses don’t throw the complaint in the bin. So there is a process – and as far as RNZCGP is concerned, that box is ticked. But prisoners are still dying. When they do, the box is a really big one – it’s called a coffin.