Dental torture – ‘tangible negligence by government officials’

The Human Rights Data Project defines torture as:

“The purposeful inflicting of extreme pain, whether mental or physical, by government officials or by private individuals at the instigation of government officials. This includes the use of physical and other force by police and prison guards that is cruel, inhuman, or degrading, and deaths in custody due to tangible negligence by government officials.” 

This post, ‘80% of countries use torture – New Zealand is one of them‘, explains that democracies tend to use ‘clean’ torture techniques that leave no physical signs of abuse. It also explains that psychological torture techniques produce similar levels of post-traumatic stress disorder as physical torture.  This link describes the psychological impact of the Corrections Department’s Medicines Policy which actively discourages prison doctors from prescribing opiate painkillers and other medications to prisoners – leaving them in severe pain and often forcing them into withdrawal.

Minimum dental services policy

Corrections also discourages dentists from providing proper dental care to prisoners.  In 2012, the Ombudsman issued a 157 page report titled: Investigation of the Department of Corrections in relation to the Provision, Access and Availability of Prisoner Health Services. It was highly critical of the Department pointing out that nearly half of the country’s 8,500 prisoners reported problems with their teeth. It said:

Management at Corrections don’t care. They have what the Ombudsman calls a ‘minimum dental services policy’ which is similar to their ‘discouraged medication policy’.  The ‘minimal services’ are supposedly justified by Section 81 of the Corrections Regulations 2005 which states:

“Any examination or treatment must be primarily concerned with the relief of pain,  the maintenance of a reasonable standard of dental care relative to the dental and oral health of the prisoner concerned before the prisoner was admitted to the prison, or both.” 

The Department interprets this regulation to mean that if inmates had poor dental care prior to coming to prison, it will continue to provide poor dental care.  For most prisoners, all the Department offers is low level pain relief.  Prisoners with tooth decay or toothache inform the prison nurse who (may or may not) put them on a waiting list. For prisoners on the list, no matter how bad the pain, all the nurses will provide is panadol.  That’s because the ‘discouraged medication policy’ inhibits doctors from prescribing strong pain killers.

Extraction is the standard procedure

When a prisoner finally gets to see the dentist, all the dentist is allowed to do is extract the offending tooth.  Amalgam fillings are not permitted for offenders who came into prison with bad teeth.  In The Effects of Imprisonment on Inmates and their Families Health and Wellbeing, Dr Michael Roguski says:

“This restrictive eligibility criterion was said to result in tooth extraction as the standard form of prison dental treatment. In a number of cases, participants indicated that teeth are extracted regardless of whether tooth restoration, such as a filling, is the more appropriate or the easier course of action.”

Sometimes even extraction is not available.  This painful policy is more likely to be applied to short term prisoners. Those who are going to be released within 12 months usually get no dental treatment at all. One inmate described his ordeal to the Ombudsman like this:

“I put in a chit to see a nurse about my tooth which was decayed. She declined to put me on the dentist’s list. Some months later, I saw the nurse again because it was sore at night. She told me to take Panadol. My tooth finally abscessed and, when I saw the nurse, I was told that because I was getting out soon, I could see a dentist then.”

The reality is that 80% of the 20,000 people who end up in prison each year are released within 12 months.  Panadol is ‘dished out like lollies’ but opiate pain killers are not allowed. If prisoners are in severe pain, they may be lucky enough to have the tooth extracted, but that’s all. No attempt is made to provide fillings or save the tooth before it needs to be extracted.

Long waiting lists

The rules are slightly different for the 20% of inmates who are in prison for more than 12 months. But even for this group of prisoners, getting to see a dentist in prison is still extremely difficult.  The Department has difficulty even finding dentists who are willing to work in prison. In 2012 the Ombudsman reported that no dentists were available in Christchurch and a Wellington dentist had to be flown down to provide dental care at all three Canterbury prisons.

Arohata women’s prison has never had a dentist.  Once a fortnight, female prisoners at Arohata are transported to the health centre at Rimutaka prison to see the dentist. On dental days, the Rimutaka Health Centre is closed (to males needing medical attention), because female prisoners are not allowed to mix with male prisoners.

At other prisons there are long waiting lists. As a result, some prisoners resort to pulling out their own teeth. One prisoner described his experience to Dr Roguski like this:

The Ombudsman concluded:

“Very few prisoners we spoke to commented favourably in respect to dental services. At the prisons we visited, prisoners regularly complained about delays in dental treatment. Not only did they complain about suffering pain during such delay, but referred to additional dental problems such as infection and abscess by reason of the delay.”

“The length of waitlists for prisoners requiring dental treatment indicates a failure to meet the Department’s Performance Standard B.06 (Dental Care) that states: “the dentist’s practice hours are adequate to meet the prescribed minimum dental services for each prisoner”. It would appear that the dental service is not being resourced at a level which reflects the high levels of dental need which exist in New Zealand prisons.”

What the Ombudsman should have said is that the Department spends $1 billion a year on containment and security but is incredibly reluctant to spend money on ensuring that prisoners have adequate dental care. This reluctance causes intense suffering for thousands of prisoners on a daily basis. It constitutes cruel, inhumane and degrading treatment and is a breach of the Department’s duty of care.

The reality is that withholding treatment from patients in severe pain is a form of psychological torture.  Since there is an official regulation justifying this policy, this is institutionalised torture – due to tangible negligence by government officials.

Democracies like to use ‘clean’ torture techniques – leaving no visible signs of the suffering they cause. But if we look more closely, there are signs. Most of these victims leave prison with substantially fewer teeth than they started with.  But who’s counting?  Not the Corrections Department, that’s for sure.