The Waikato Times recently printed a story with the headline ‘Obscene amount spent on prison healthcare.’ It said that in 2013, the Corrections Department spent $24 million on healthcare and the writer, Belinda Feek, said “The spend has left some commentators outraged knowing that offenders would get immediate access to care while many of their victims are forced to wait a number of years.”
The only outraged ‘commentator’ mentioned in the story is Ruth Money (left) of the so-called Sensible Sentencing Trust. Ms Money clearly knows nothing about the availability of medical care in New Zealand prisons – so she made up some nonsense which the Waikato Times then published as if it was true.
Let’s look at a few facts. The story has only one accurate statement. It quotes Bronwyn Donaldson, the director of offender heath for Corrections, who notes the Department has “a statutory obligation to provide a primary healthcare service to prisoners that is reasonably equivalent to that found in the community.” That ‘fact’ is established by section 75 of the Corrections Act 2004.
The ratio of doctors to prisoners
Everything else in the story is dodgy. In order for there to be any chance of an ‘equivalent’ level of care in prison, key features of the systems need to be similar. For instance the ratio of doctors to prisoners needs to be similar to the ratio of doctors to patients in the community. But Corrections doesn’t get anywhere near this. In 2010, there were 13,883 full-time general practitioners in New Zealand. This translates to 317 doctors per 100,000 of the population – or one doctor for every 315 people.
The Times story mentions Springhill and Rangipo prisons. Springhill, with 1050 prisoners, has a doctor on duty for only 18 hours a week. That’s a ratio of one full time doctor for 2,333 prisoners. Rangipo, with 540 prisoners, has a doctor on duty for only seven hours a week. That provides a full time equivalent of one doctor for 3,085 patients. With those ratios, the chance of prisoners getting “immediate access to care” is almost zero. The reality is that one of the most common complaints made by prisoners is that they can’t get to see a doctor when they need to – which sometimes has fatal results. Jai Davis, who was admitted to Otago prison in 2011 suspected of ‘internally concealing’ drugs. He died two days later because there was no doctor on duty and none of the nurses or prison staff bothered to call one.
In order for prisoners to receive equivalent care, they also have to have access to the same drugs and medications available to the public. But they’re not. Section 6.1.1 of the Department’s medication policy states: “Prescribing medication that can be misused/abused or has some economic value in a prison environment (or example benzodiazepines, opioids and zopiclone) is actively discouraged. A clinically suitable alternative medication or treatment option is preferred.”
Opioids are used for the relief of severe pain. But this ‘discouraged medication policy’ extends well beyond pain relief. All medications including antidepressants and antipsychotic drugs are taken away from prisoners – usually on their first day in prison – while the nurse checks with the prisoner’s GP. Although this practice varies from one prison to another, often such medications are never reinstated. In The Effects of Imprisonment on Inmates’ and their Families’ Health and Wellbeing Dr Michael Roguski, provides numerous case studies which illustrate the suffering this policy causes. It contributes to depression, anxiety and sometimes to suicide.
Given these deficiencies, it is not surprising that the suicide rate in prison is five to six times higher than the suicide rate in the community. In 2011, so many prisoners killed themselves it was eleven times higher. That’s a fact.
Medical ethics and the Crimes Act
The reality is that denying patients clinically appropriate medication, especially those in severe pain or with mental health disorders, is inhumane and a breach of human rights. If prison doctors follow this policy, they’re breaching their medical ethics which require them to put the welfare of their patients first – rather than arbitrary prison policies. They could even be charged with breaching section 151 of the Crimes Act which requires anyone with vulnerable individuals in their care: “to provide (those) person(s) with necessaries; and take reasonable steps to protect (those) person(s) from injury.”
The quality of medical care in New Zealand prisons is so poor that in September 2013, Radio New Zealand revealed that the police are investigating the allegations into Jai Davis’ death and are reviewing the suicide of another prisoner. Richard Barriball had three different medications taken off him as soon as he was remanded in prison in 2010. He died after being in prison for less than a week. Three former prison doctors interviewed by RNZ are all calling for an inquiry.
A final comparison that needs to be made relates to the amount spent on prison healthcare. Ruth Money calls the $24 million spent on prisoners an ‘obscene amount’. But this is less than 2% of the Department’s annual budget of $1.4 billion. Compare that with the $14 billion which the government spends on healthcare in the community – out of a tax take of $60 billion a year. That’s 23%. In other words the government spends 11 times more on healthcare in the community than Corrections spends on the healthcare of prisoners. There are approximately eight times as many full time doctors per patient in the community as there are doctors per prisoner. Now that is obscene. And the Waikato Times let Bronwyn Donaldson get away with saying Corrections provides an equivalent standard of care. What standard of journalism is that?