Don’t get sick in the Otago prison – cause no one gives a shit

Being sent to prison in Otago is hazardous to your health. If you get sick, you may well die because you won’t get much help from the prison nurses or doctors.

In 2010, Richard Barriball committed suicide in the Otago prison after he was unable to access the painkilling medication he had been receiving in the community for an injury to his arm. The coroner, David Crerar, criticised Corrections for providing Mr Barriball with ‘sub optimal treatment’.

In 2011, Jai Davis died when prison nurses refused to call a doctor even though Mr Davis was admitted to the prison with internally concealed drugs (codeine and benzodiazepines). Davis was responsible for swallowing the drugs, but David Crerar was critical that half a dozen nurses on duty that weekend ignored his deteriorating condition and none of them called the doctor.

The same coroner has just revealed that in 2012 Boyd Cuttance spent 48 days in Otago prison. He developed an invasive fungal infection in the brain and sought help for severe headaches 30 times during those 48 days. He was only transferred to hospital after his mother who happens to be a nurse went to see him, discovered he was ‘extremely unwell’ and demanded he be sent to hospital. He died two months later.

The coroner, Mr David Crerar, cleared Dunedin Hospital staff of any wrongdoing but found prison management, doctors and nurses were totally wrong in thinking the actions they had taken constituted ”appropriate health care”. All they did was take a blood test and give him some panadol. Mr Crerar said Mr Cuttance’s symptoms ought to have indicated to an experienced nurse or GP that something was seriously wrong with him.

Today, the Otago daily Times reports that yet another prisoner has committed suicide in the Otago prison. It will be interesting to see what involvement he had with the prison health service before he decided to take his own life. Given the speed at which the coroner works, it’ll be another three years before we know the answer to that.

But the real question is how many more people have to die before David Crerar gets sick of molly-coddling Corrections and demands an official inquiry into the Otago prison health service. If he doesn’t, the Health & Disability Commissioner or the Ombudsman certainly should. But that’s not going to happen is it. Why? Because they’re prisoners, not human beings, and no one gives a shit. Except their families.

Ombudsman colludes with Corrections to cover up responsibility for ‘unnatural’ prison deaths

The death of Jai Davis in 2011 has highlighted critical deficiencies in the management and nursing culture at the Otago prison. Now there’s an even wider concern. Documentation has come to light showing the Ombudsman colluded with Corrections, albeit unintentionally, to cover up the circumstances surrounding his death which implicate management and nurses at the prison.

This is how it happened. When a prisoner dies suddenly from an unexpected death, this leads to at least three different investigations – one by the Corrections Inspectorate, which is monitored by the Ombudsman; one by the Police, which may be monitored by the IPCA (if there’s a complaint); and finally one by the Coroner. Each investigation has a different focus. The role of the Inspectorate is to determine whether any Corrections procedures or protocols were breached, and whether any prison officers should be disciplined. The Inspector also makes recommendations to the chief executive to prevent it happening again.

Corrections Inspector David Morrison’s report

Responsibility for investigating Jai Davis’ death on behalf of the Corrections Inspectorate was given to David Morrison (right). While interviewing prison staff about the circumstances, he was accompanied by a representative from the Ombudsman’s office. The Ombudsman’s role was twofold: to ensure Mr Morrison did his job properly, and to ascertain whether Mr Davis received appropriate medical care and had been treated humanely while in prison. In other words, the Ombudsman was supposed to ensure the Inspector got to the bottom of what Corrections did right – and what they did wrong.

Mr Morrison never got to the bottom of anything. (Here’s the executive summary of his report.) He was well aware that Acting prison manager, Ann Matenga, had statutory responsibility to advise the Medical Officer that a prisoner had been admitted suspected of having drugs on board – but never held her to account for not doing so. Mr Morrison also failed to make any findings against the nurses, even though they clearly failed to provide Mr Davis with adequate medical treatment. The only staff he made findings against were two officers who made fictitious observations that Mr Davis was snoring in the early hours of Monday morning – by which time he was already dead.

David Morrison’s recommendations

Mr Morrison refused to point the finger at anyone further up the chain of command. His key recommendation was that:

“The Department of Corrections considers establishing a protocol with the Ministry of Health to facilitate the x-ray of a prisoner where it is suspected a prisoner is internally concealing an unauthorised item that in the opinion of the Medical Officer may place the prisoner’s health at risk.”

Corrections already had a protocol in place to manage that situation. It said that when a prisoner is suspected of internal concealment, the Medical Officer is to be advised. The problem is that since the nurses and prison managers ignored the existing protocol, they could just as easily ignore any new protocol. So that wouldn’t be much help. To address that difficulty, Mr Morrison’s second recommendation was:

“All key prison staff and health service personnel are trained and adhere to the requirements under the Prison Service Operating Manual (PSOM)…”

Great – except that Corrections staff are already trained in the PSOM – it’s like the prison officers’ Bible. All they have to do is look it up to see what to do in any given situation.

The nursing culture at Otago prison

The reality is that Mr Davis’ death had nothing to do with a lack of training. It had to do with a lack of compassion and personal responsibility. The nurses who ‘treated’ Mr Davis, but refused to call the prison doctor, were all trained health professionals. They have two Bibles of their own – the Nurses Code of Ethics and the Code of Conduct. These describe the ethical and legal responsibilities that nurses have to their patients, irrespective of Corrections Department protocols. The problem was they ignored their ethics and the Code of Conduct because of a culture of incompetence and indifference that operated in the Otago prison health centre.

The only way to change that culture is for the nurses who are guilty of professional misconduct to face a Departmental employment investigation and be brought before the appropriate disciplinary bodies – which would include the Nursing Council and the Heath & Disability Commission. If the police did their job properly, and prosecuted nurses who were guilty of gross neglect, some of them would also be brought before the Court.

But Mr Morrison made no such recommendation. His 44 page report does not hold anyone to account for their failure to call the prison doctor – despite the fact that this was the most significant act of negligence in a succession of negligent acts culminating in Mr Davis’ death. In other words, Mr Morrison’s report was a whitewash.

The Ombudsman’s response

Here’s the crunch. Despite the report’s obvious deficiencies, in September 2011 only six months after Davis died, the Chief Ombudsman, Dame Beverly Wakem (left) wrote to the Chief Executive of Corrections praising the Inspector’s conclusions. She said:

“My investigator monitored the investigation throughout. I have been provided with the Inspector’s final report and… I am of the opinion that the report is fully satisfactory and that the recommendations made by the Inspector are reasonable.”

In hindsight, that endorsement looks increasingly bizarre. At the time it was written, the police had barely begun their investigation. Who knows what crimes they might uncover? Once the police finally finished (three years later), coroner David Crerar, was able to get on with his inquiry. After hearing from 58 witnesses, the shortcomings in Mr Morrison’s investigation were disturbingly obvious and led to heated cross-examination at the inquest.

The inquest also highlighted the inadequacies of the police investigation (which led to three complaints to the IPCA), as well as the shoddy treatment provided to Mr Davis by the nurses and prison managers. The coroner was so concerned at the multitude of mistakes by those responsible, he said he intended to make adverse comments about everyone involved including: “Jai Davis, his associates, the police and certain police officers, Corrections management, certain Corrections staff and certain health centre staff.”

Even the police began to realise they might have got it wrong. On the last day of the inquest, they announced they would review their decision not to lay charges against those involved.

The Ombudsman’s role

Given what we now know about this case, it is hard to understand why the Ombudsman would so quickly, and naively, jump to the conclusion that the report by Corrections Inspector David Morrison was ‘fully satisfactory’. The Ombudsman’s role is to look after citizens’ interests in their dealings with government agencies – which includes ensuring that prisoners are not subject to cruel or inhuman treatment. But if Dame Beverley’s monitoring of Corrections is so superficial that all she does is send a representative to keep the Inspector company and then endorse his report, she’s not doing her job. The Ombudsman is supposed to be the citizens’ watchdog. The message this case sends is that the watchdog is little more than a lapdog – one with no teeth.

The reality is that David Morrison’s recommendations completely missed the mark. That could be due to incompetence. A more likely explanation is that Mr Morrison was trying to protect the reputation and careers of prison management and nurses by minimising the extent of their involvement in Davis’ death. Why? Because Corrections Inspectors are not independent of those they investigate. Mr Morrison is part of prison management; he’s hardly going to find fault with his own team.

How independent is the Ombudsman?

But the Ombudsman is independent, theoretically. She doesn’t work for Corrections – or does she? I’m not so sure anymore. Dame Beverley has endorsed Mr Morrison’s flawed report that makes no findings against prison management. Maybe she doesn’t work for them, but she’s clearly supporting their team. Here’s a bigger question. Is the lack of independent oversight by the Ombudsman in this case typical of oversight into the Best-Sleeping-Dog-Wallpaper-HD-0007 other 90 unnatural deaths which have occurred in prison in the last ten years?

The answer is – nobody knows, because the prisoners are all dead. And they’re not really in a position to lay a complaint. Even if they were – that wouldn’t help much if the watchdog just sniffs around the Corrections Inspector’s feet, and then goes back to sleep.

Solicitor General and police use fabricated evidential test to avoid prosecuting prison officers

The Solicitor-General, Michael Heron (left) has manufactured an erroneous Evidential Test which the police then use to avoid prosecuting selected offenders. The test is ambiguous, misleading and based on an entirely false premise. It seems to completely confuse the police who then use it to undermine the role of the jury.

The police used this flawed test in their decision not to prosecute any of the Corrections staff who left Jai Davis to die from ‘internally concealed’ drugs in the Otago prison in 2011. As a result, the police never gave a jury the chance to hear the evidence – let alone decide whether any prison officers or nurses were guilty of negligence or manslaughter.

Because they’d been monitoring prisoners’ phone calls, management at Corrections believed Davis had drugs inside him when he was brought to prison on Friday, 11 February 2011; so they placed him in a special observation cell, one with a camera on 24/7. After two days, his condition deteriorated dramatically, but none of the numerous nurses or prison officers responsible for looking after him called a doctor or an ambulance. After a drawn out investigation which took three years, police announced they would not lay charges against anyone involved. Detective Inspector Steve McGregor (right) claimed the evidence did not ‘meet the threshold required to proceed’.

The evidential test for prosecution

So what is the so-called ‘threshold’ for prosecution? In criminal investigations, police use the Solicitor-General’s Prosecution Guidelines to assist them. But the guidelines are confused and contradictory. For instance, paragraph 5 states:

“The Test for Prosecution is met if the evidence which can be adduced in Court is sufficient to provide a reasonable prospect of conviction – the Evidential Test. What is required by the evidential test is that there is an objectively reasonable prospect of a conviction on the evidence. The apparent cogency and creditability of evidence is not a mathematical science, but rather a matter of judgment for the prosecutor.”

Talk about confusing. One sentence uses the word ‘objectively’ as if there was a scientific test which produces a factual, clear-cut result. The next sentence acknowledges that there is no such test and whether to lay charges is entirely subject to the prosecutor’s experience and personal assessment of the evidence.

The confusion in the Guidelines doesn’t stop there. Section 2.3 says:

“They reflect the aspirations and practices of prosecutors who adhere to the United Nations Guidelines on the Role of the Prosecutor (1990) and the International Association of Prosecutors Standards (IAPS) 1999.”

No they don’t. The IAP Standards state:

“In the institution of criminal proceedings, (prosecutors) will proceed only when a case is well-founded upon evidence reasonably believed to be reliable and admissible, and will not continue with a prosecution in the absence of such evidence”.

The focus here is on evidence that is ‘well-founded’ and ‘reliable’. The IAP Standards don’t even mention an ‘evidential test’, let alone the need for a reasonable prospect for conviction. Neither do the United Nations Guidelines. In regard to criminal proceedings, they state:

“Prosecutors shall not initiate or continue prosecution, or shall make every effort to stay proceedings, when an impartial investigation shows the charge to be unfounded.”

An unfounded charge is one in which the investigation establishes that no crime has been committed. This is an entirely different matter from the Solicitor General’s requirement that, where a crime has been committed, there should also be a reasonable prospect of conviction.

In other words the New Zealand Guidelines are confused and misleading on at least two separate points. In regard to criminal prosecutions, they are not based on the International Standards. And they suggest there is an objective evidential test for prosecution when clearly there is not. This means the Solicitor General’s requirement that a prosecution should only proceed if there is an objectively reasonable prospect of conviction is a judicial aberration – one that enables police to completely undercut the role of the jury.

Usurping the role of the jury

That’s what happened in the Jai Davis case. Fortunately, once the police washed their hands of it, the coroner was able to take a look at the evidence. The inquest in November 2014, held by David Crerar (right), turned out to be the longest and most intensive hearing into the death of a prisoner ever conducted in New Zealand. It uncovered a wealth of well-founded and reliable evidence much of which has been documented in the media. In essence, the coroner heard that at least ten officers, six nurses and three prison managers all believed Davis was internally concealing drugs – but not one of them called the prison doctor or called an ambulance.

The evidence was so compelling that at the end of the inquest, police announced they would reconsider whether to prosecute. Presumably the potential charges are ‘failing to provide the necessaries of life’, ‘gross neglect of duties’ and possibly ‘manslaughter’.

The Police need to do their job and prosecute those involved. If they don’t – because they might not get a conviction – they let the perpetrators go free without even allowing a jury to look at the evidence. In effect, the police appoint themselves as judge and jury. That’s not how the system is supposed to work. The role of the police is to present well-founded, reliable evidence that a crime has been committed. It’s up to the jury to decide whether that evidence is sufficient for a conviction to be reached beyond reasonable doubt.

Police double standard

It’s not just the Solicitor-General’s Guidelines that are problematic. The police also have a well-established double standard when it comes to prosecuting crimes of negligence. They frequently charge offenders in the community for negligence or failing to provide the necessaries of life to vulnerable family members – but never charge anyone at Corrections when a vulnerable prisoner dies. The reality is that Jai Davis is just another dead prisoner in a long line of prisoners where a jury never got to hear the evidence.

That’s not justice. That’s corruption – and it’s been going on for years. One could even argue that by consistently refusing to prosecute and hold prison staff to account, this amounts to a conspiracy to pervert the course of justice by agencies of the State – namely the Solicitor-General, the Police and Corrections. Perverting the course of justice carries a possible penalty of seven years in prison. But I can’t see anyone being prosecuted for that. It wouldn’t meet the evidential test, would it? Of course not.

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For a more detailed critique of the evidential test, see this letter to the IPCA about the police failure to prosecute anyone over the death of Jai Davis.

For a more detailed analysis of police double standards, see this letter to the IPCA comparing police prosecutions in the community with those against prison staff.

Police excuse for prisoner’s death – we didn’t read our emails!

Jai Davis died in Otago Correctional Facility (OCF) three years ago after internally concealing drugs in his rectum. In a previous post, it was revealed that prison management’s reluctance to pay $300 to call out a doctor on the weekend was a factor contributing his death. This wasn’t the only factor. At the coroner’s inquest yesterday, the Police also came under attack – for not reading emails which could have saved Davis’ life.

Corrections had been monitoring phone calls to Davis by gang members in prison. The calls revealed that Davis was about to turn himself into police (on domestic assault charges) and was told to bring in ‘candy’ – code for prescription drugs.

Corrections warnings to police

Corrections intelligence officer Neil Jones-Sexton told the coroner’s inquiry on Monday that this information was of such significance, he immediately warned the police. He made numerous phone calls to a variety of police personnel advising them that Davis was going to present himself at the Dunedin police station to be arrested – and would be internally concealing drugs. He also sent at least two emails to police along with a synopsis of the calls recorded by Corrections.

The evidence given by Mr Jones-Sexton was corroborated by police intelligence analyst, Rennae Flockton who also testified yesterday. She said there were six or seven staff in the Dunedin intelligence office. There was a warrant out for Davis’ arrest and the analysts were all aware and even discussed the possibility that he might turn up at the police station. When he appeared the next day, she and “other Intel staff members” went and “looked at him through the mirrored glass” and “were commenting as to how he may have the drugs hidden on him to take into OCF.”

The Misuse of Drugs Act

Under Section 13 of the Misuse of Drugs Act, the police have the power to detain on belief of internal concealment. Under Section 13C, they have to call a doctor to conduct an internal examination of a detained person which may include an x-ray. Police detained Davis and held him in police cells overnight. The next day, they took him to court and then out to the Otago prison. During all this time, they never bothered to call a doctor. They were lucky he didn’t die in the police cells.

Last year I wrote to the IPCA pointing out that the police were well aware that Mr Davis was suspected of internally concealing drugs when he turned himself in. I asked the IPCA to investigate the failure of the police to use their powers under the Misuse of Drugs Act – which could have saved Mr Davis’ life. On behalf of the IPCA, Inspector Geoff Jago, made a superficial investigation of the police conduct and decided the police were unaware that Davis had drugs on board.

What the IPCA missed

Jago said that Jones-Sexton only sent two emails about the matter – both on Wednesday 9 February (the day before Davis turned himself in). The first email went to Police Detective Sergeant John Hedges who was head of the Organised Crime Squad in Dunedin. Sent at 9.38am, it read: “We are working on a disclosure on the MM (Mongrel Mob) where they are looking to introduce drugs”. Further on, the email mentions Davis by name. At the inquiry yesterday, Sergeant Hedges said he never read this email and wouldn’t have done anything about it, even if he had – because he was too busy.

Jones-Sexton sent the second email at 4.00pm that afternoon to Sergeant Tony Ritchie who was head of the Police Intelligence Unit in Dunedin (where Rennae Flockton worked). Apparently, Sergeant Ritchie knocked off work at 2.00pm and claimed he never read the email till he got back to work a few days later – long after Davis had died. Even if this is true, Rennae Flockton said everyone in the police Intel office already knew what was going on – because Jones-Sexton had told them on the phone.

Excuses by Corrections & Police

There’s absolutely no doubt the police knew Davis was carrying drugs when he turned himself in. They displayed the same callous attitude as Corrections – they never called a doctor to conduct an examination. Corrections excuse was they didn’t want to spend $300 to call out the doctor on the weekend. The Police excuse, backed up by the IPCA, is that they didn’t read their emails.

The reality is that Davis died because staff at both Police and Corrections failed to do their jobs properly. When members of the public fail to take care of vulnerable people in their care, they often get charged with manslaughter. Police took three years to finish their investigation into Jai Davis’ death. In the end, they never charged anyone.

Prisoner dies because Corrections reluctant to pay $300 for doctor on weekend

Jai Davis died from a drug overdose two days after being remanded to Otago prison in February 2011. The inquest into his death starts in Dunedin next week – on Monday 24 November, 2014. The hearing is likely to last two weeks and will expose numerous failings by prison management, prison nurses and prison officers who all knew Davis was ‘internally concealing’ drugs but never bothered to call a doctor or an ambulance.

Here’s the background. Knowing he was going to be arrested, Davis tried to smuggle in codeine and benzodiazepines for some other prisoners. Corrections knew he had drugs inside him because they’d been monitoring phone calls from these prisoners asking Davis to bring in some ‘candy’ when he turned himself in.

The police also knew Davis had drugs on board because Corrections told them. They asked police to keep him away from other prisoners when he appeared in court – in case he tried to pass the drugs on.

Once he was taken to prison, Corrections put Davis in a special ‘dry’ cell for ‘At Risk’ prisoners. These cells don’t have toilets. When the inmate wants to ‘go’, he is given a cardboard potty and is watched while he defecates. Once he’s done, prison officers look though the faeces to see what came out. Corrections put Davis in one of these observation cells so they could catch him with the drugs and charge him with smuggling in contraband.

Prison manager failed to call doctor

The manager at Otago Correctional facility is Jack Harrison (below). Throughout the two days that Davis was in prison, his team (managers, nurses and prison officers) broke all their own rules. One of those rules is: “The Management of Prisoners Suspected of Internally Concealing Unauthorised Items”. It clearly states that prison management is required to “inform a medical officer (a doctor) that the prisoner is being confined to a dry cell”. The prison manager, Ann Matenga, who was on duty when Davis was admitted signed a form stating she would advise the doctor of the situation. She never did.

On the Sunday morning, two days after he was admitted, Davis was clearly not well. One of the prison officers who was monitoring him subsequently told police:

“The nurse was assessing Davis. I stood at the cell door while she did this. Jai (Davis) looked like a corpse, he was grey coloured and was scratching badly – his arms were real red. His eyes were sunken and he had the cold sweats. He was definitely not his usual self and he had slurred speech as well. To my mind, he was showing all the signs of someone being on drugs. What’s more his breath smelt like faeces. I could smell it from where I was when he was talking to the nurse. The nurse said he was fine and that was that. I thought to myself, I am glad that’s your call, because to me, he looked as though he should have been in hospital.”

Another nurse who was on duty later that afternoon, Janice Horne, also thought Davis was under the influence of drugs. Corrections investigator, David Morrison, wrote: “Her assessment of Mr Davis at this time was that he was under the influence of some drug because of the slow movements that he was making”. Janice Horne knocked off work at 8.00pm that evening and subsequently told Mr Morrison (and the police) that she saw no reason to call a doctor. She thought Mr Davis was fine, even though he was clearly under the influence of drugs. Davis died two hours later. There was a camera in the cell recording every movement he made and the last one, the ‘death shake’, was at 10.01pm, two hours after Ms Horne went home. By the time prison officers realised he was dead – at about 5.00am the next morning – his body was already stiff from rigor mortis.

Life is cheap in Otago prison

Davis was seen by five different nurses over the course of the weekend. They all knew he was in the ‘dry’ cell suspected of internally concealing drugs. Not one of them called the doctor. They didn’t even call the health centre manager. Nurses have a Code of Conduct which requires them, among many other obligations, to “Act promptly if a health consumer’s safety is compromised.” All five nurses responsible for Mr Davis’ health care over the weekend abandoned their ethics and ignored the Code of Conduct.

When the nurses were subsequently interviewed by the police and asked why they didn’t call the doctor, two of them said that cost was a factor. They said that calling the doctor out on the weekend was discouraged because the prison is 45 minutes’ drive from Dunedin where the prison doctor lived and a callout cost $300. Life is cheap in Otago prison.

Despite so many Corrections staff failing to perform their duties in this case, not one Corrections manager, officer or nurse was charged with a crime. Why? Because the police also knew Davis was internally concealing drugs; with that knowledge, they held him in the police cells overnight and took him to court and then to Otago prison the next day. But they couldn’t be bothered calling a doctor either. They just chucked Davis in prison. My guess is that the police didn’t want a judge, or the public, to find out that they also contributed to his death.

Severe neglect leads to prison sentence – except when the victim is a prisoner

In November 2011, 82-year-old Maureen Quinn was found malnourished and dehydrated lying on the sofa with maggot infested leg ulcers. Medical staff said it was the worst case of neglect they had seen and Maureen died six weeks later. Joanne Quinn (right), her eldest daughter, was charged with failing to provide the necessaries of life and in May 2014 was sentenced to two years and six months in prison.

Here’s another case of neglect which has not received the same level of public attention. 30-year-old Jai Davis was admitted to Otago prison on remand on Friday 11 February, 2011. He also needed medical help, but he died two days later because prison staff couldn’t be bothered taking him to the hospital. They never even called a doctor.

The set up

Here’s what happened. Mr Davis (right) was connected with the mongrel mob. and gang members in the Otago prison wanted drugs brought in. They were aware that Mr Davis had assaulted his girlfriend and was likely to end up in prison again.

So once charges were laid, gang members phoned him telling him to bring in ‘candy’ – and conceal it internally. After a brief appearance in court, Mr Davis was remanded in prison. Prison management knew he was concealing drugs because they’d been monitoring the gang member’s phone calls. (The Department monitors all phone calls made by prisoners.)

Official procedures ignored

Corrections have a documented procedure for dealing with “prisoners suspected of internally concealing an unauthorised item.” It requires the prisoner to be taken to a dry cell (one with no toilet or running water) and “a medical officer (the prison doctor) is to be informed”. Davis was remanded late on Friday afternoon so there was no doctor was on duty. Doctors are seldom on duty in New Zealand prisons – see Prison deaths linked to Corrections refusal to employ sufficient doctors.

Because management suspected Mr Davis of concealing drugs, the acting prison manager signed a document stating she would advise the prison doctor of the situation. She never did. Over the course of the weekend, officers and nurses observing Mr Davis noticed him staggering around in his cell apparently under the influence of drugs.

Prison Inspector, David Morrison, subsequently wrote a 39 page report outlining the circumstances which contributed to Mr Davis’s death. He wrote:

“At approximately 16:00 hours (4 p.m. on 13 February, the day he died), Mr Davis was seen by the nurse, who had been informed when she came on duty that Mr Davis was suspected of concealing drugs and that was why he was in the dry cell… Her assessment of Mr Davis at this time was that he was under the influence of some drug because of the slow movements that he was making” (para 171).

“The PM Nurse had a conversation with the unit officer where she stated to the officer, Mr Davis ‘looks stoned’ “ (para 172). Mr Davis was more than stoned. The autopsy report shows he died from the combined effect of ingesting codeine and benzodiazepines.

At about 7.30 that evening one of the officers responsible for observing Mr Davis became concerned about his deteriorating condition. He called the nurse and asked her to come and check on Mr Davis again. The nurse was about to finish her shift at eight o’clock and replied that she had already seen the ‘little fucker’ earlier in the day. She had a dinner date organised and refused to go. Mr Davis died about three hours later – at 10.30 that evening.

It’s all on camera

Because he was “at risk” there was a camera in Mr Davis’ cell – everything that happened was recorded. The camera footage shows that Mr Davis remained on his bed from 10 p.m. that night “without moving”. In addition to the camera, officers were supposed to personally check on him every 15 minutes. In his report, the prison inspector said that “the scheduled standard 15 minute observations for 21:32 hours (9:32 p.m.) and 22:25 hours (10:25 p.m.) were not conducted… (But) these observations were recorded as being completed by the officer.”

In other words, around the critical period when Mr Davis stopped moving, the prison officer who was responsible for checking on him failed to do so – and then falsified documents claiming that he had. See Prison records ‘ghosted’. It was not until 5.00am that an officer became concerned that Mr Davis didn’t seem to be moving. When they finally entered his cell to rouse him, rigor mortis had already set in indicating he had been dead for hours. Corrections Inspector David Morrison concluded that at least seven different prison protocols had been breached.

No investigation

Let’s compare Mr Davis’s case with a couple of other cases. In August 2010, a mother in Auckland was charged with murder but found guilty of manslaughter after her 13-month-old baby drowned in the bath while she left the baby unattended for 15 minutes. She was sentenced to 17 months in prison (on appeal). In October 2013, a Wellington mother was charged with manslaughter after her baby also drowned in the bath while she made a phone call which lasted 6 minutes. She was found not guilty.

Each of these women had a vulnerable family member in their care for whom they were responsible. After a thorough police investigation, they were charged with manslaughter, murder or ‘failing to provide the necessaries’ because in each case they failed to protect the one who died. In Mr Davis’ case, Otago prison also had a vulnerable person in its care – and also failed to protect him. But for two whole years the police did absolutely nothing. An investigation only began after a formal complaint was made to the IPCA.

No one charged

The Police eventually put ten officers on the case and interviewed over 70 Corrections staff – some of whom had gone to Australia. The investigation took 12 months – but in the end, no one was charged with anything. According to Radio New Zealand, police claimed “there was ultimately not enough evidence to meet the threshold required to run a successful criminal prosecution”. Yeah right!

There are at least four possible reasons why no one was charged. The first is that Mr Davis was a prisoner, perceived by the public as a second-class citizen – and prisoners deserve what they get. Maybe that’s why the police took so long to start their investigation. The second is that a number of people were involved in monitoring Mr Davis over the weekend and no one person was ultimately responsible for his death. That’s easily solved. Bring charges against everyone and let the jury decide.

The third possibility is that police were reluctant to press charges because it might have been suggested at trial that they also contributed to Mr Davis’s death – by taking him to prison when they should have taken him directly to hospital. When she was asked about Mr Davis’ death, the prison health centre manager (who was not on duty the weekend that Mr Davis died) said:

“As there was clear knowledge that this person was concealing drugs, why did he come here in the first place? The prison is 45 minutes away from a hospital. If drugs had exploded in the prisoner’s gut, we would not be able to get (him) to the hospital in time. If there were serious concerns that this man had drugs on board, he should have been held in hospital under guard where he could be treated quickly if things went wrong” (Corrections Inspector’s report para 195).

Political interference?

The fourth possibility is that there has been political interference. Anne Tolley is Minister of Police and Corrections. She was aware of Mr Davis’s situation at least as far back as Septem- ber 2013. See Prison deaths investigated. She and Police Commissioner Peter Marshall took a keen interest in the case and were kept informed of developments by Dunedin Inspector Greg Sparrow who was in charge.

Inspector Sparrow also kept Mr Davis’s mother, Victoria Davis, informed – and Victoria thought that someone at Corrections would eventually be charged. But once the investigation was complete Ms Davis was told that Inspector Greg Sparrow had suddenly gone ‘on leave’. He was replaced by Detective Inspector Steve McGregor who seems to be higher up in the police chain of command. Peter Marshall and Anne Tolley are at the top of the chain.

Given the extraordinary decision that no one will be charged, it may well be that Anne Tolley has also crossed the line and interfered with a police prosecution. After the Judith Collins Oravida scandal and the resignation of Maurice Williamson, the last thing National wants to see is Police prosecuting Corrections over the death of a prisoner a few months out from the election.

All four of these possibilities are worthy of investigation – whether that’s by the coroner, the IPCA or the media.

The big picture

The inquest into Jai Davis’s death will be held from 3rd to 7th November, 2014 – but it seems unlikely the coroner will examine the big picture – despite the fact that Mr Davis’ death in prison is not an isolated case. Over 80 prisoners have died ‘unnatural deaths’ in custody in the last ten years – but not one prison officer, prison nurse or prison manager has ever been charged with anything. If the police fail to investigate prison deaths, and never press charges against anyone – a conspiracy theorist might conclude that Corrections and the Police are involved in a cover-up. Eighty dead bodies kept under wraps – the whole thing stinks.

Compare this with deaths in the forestry industry. On average about five forestry workers die every year and companies which fail to protect workers are often ordered to pay significant compensation. Four days ago, Coroner Wallace Bain (right) called the death rate in the forestry industry “alarming” and said “New Zealand’s health and safety record is extremely poor”. About five prisoners also die unnatural deaths in the care of the Corrections Department every year. In 2011, eleven prisoners died – but no one bats an eyelid. Why? Because they’re only prisoners, so who cares – and no one is really looking anyway, including the police. In Jai Davis’ case, the police eventually did have a look – but then they closed their eyes again.

The obscene Money money story – as reported by the Waikato Times

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.

Corrections’ discouraged medication policy

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.

Financial comparisons

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?

Abused inmate with complex-PTSD spends 35 years in prison with no treatment

Trevor is 61 years old. He lights fires when he’s drunk. He has 17 convictions for arson but is usually so drunk when he sets fire to something, he doesn’t even remember doing it. His lawyer asked me to conduct an alcohol and drug assessment on him late last year after yet another arson conviction.

Trevor’s mother was an alcoholic. As he was growing up, his parents fought and argued finally splitting up when he was just seven. During the conflict and confusion, Trevor was shunted between his parent’s homes before they both gave up on him and put him into the care of the state – at the age of nine. Over the next few years he lived in half a dozen foster homes, occasionally going back to stay with his mother for a few months, before she kicked him out yet again. He started drinking when he was 12.

The abuse

Not surprisingly Trevor grew up feeling anxious and insecure. At age 16, he was sent to Lake Alice hospital where he was given shock treatment. That really pissed him off and a couple of days later, he set fire to his bed. That was the first one. Two years later, he ended up in prison – where he was repeatedly raped by an older prisoner. The abuse went on for three years. By the time he got out at the age of 21, Trevor was suicidal, filled with rage and didn’t trust anyone. He was deeply, deeply disturbed.

As soon as he got out of prison Trevor started drinking. He’s been in and out of prison ever since – 15 times to be precise. He drinks, generally commits some petty offence, lights another fire and watches it burn. That’s when the police come and arrest him. At the age of 61, he now has over 100 convictions and has spent 35 of the last 40 years in prison. He has no friends, no support in the community and says he feels safer in prison.

Each time he ends up in court, the judge usually wants to know why he lights fires – and they wonder if he’s insane. Sometimes an enlightened judge orders a psychiatric assessment. Just before I saw him in 2013, Trevor had been interviewed by a clinical psychologist and a psychiatrist. I read the reports. They both decided he wasn’t insane – but neither of them made a diagnosis. They didn’t seem to know what was wrong with him.

Complex-PTSD

I believe I do know what’s wrong with Trevor: he has Complex-Post Traumatic Stress Disorder. This is an enduring version of PTSD which results from prolonged exposure to interpersonal trauma. The trauma is exacerbated when it occurs in the context of captivity or entrapment and affects the development of the victim’s thinking and personality. Individuals with complex-PTSD generally experience a profound sense of emptiness, chronically low mood and social isolation – combined with intense anger and rage.

At the age of 61, Trevor experiences all of these and still thinks about what has happened to him every day. But he is polite and articulate. Talking about his life in a calm manner, he simply said: “What a lot or people have done to me is unforgiveable.” But when he gets out of prison, he drinks to help him forget about it. He lights fires when he’s drunk because that’s what he learnt to do at age 16 when he was disempowered, lonely and distressed. These days, it returns him to the safety of prison.

Trevor has now spent 35 years inside. During this time, he has never even been diagnosed with PTSD let alone had had any counselling or treatment for it. The psychologist who interviewed him in 2013 wrote:

“Trevor Xxx was interested in receiving therapy with regard to his angry feelings, attachment issues and sexual abuse. Sexual abuse victimisation can be addressed by ACC sensitive claims. Therapy in these areas is likely to reduce his risk of reoffending.”

No therapy was provided. In my report to the court, I wrote:

“The Department should have provided counselling for Mr Xxx’s childhood trauma 40 years ago. Having then allowed him to be raped and abused in prison, the Department should have provided therapy every time he subsequently ended up in prison. If it had, it is possible Mr Xxx would no longer need to anesthetize himself with alcohol every time he gets out.”

The cost of insanity

Trevor is far from insane. He has both insight and intelligence. He knows he’s an alcoholic; he knows he lights fires when he’s drunk and he knows that makes him a risk to society. He also understands that society has to be protected from someone like him. He even knows the system sucks and he’s not going to get any help in prison. He told me the Corrections Department doesn’t have the resources to provide him with a psychologist to actually try and help him.

He’s absolutely right about not getting any help. But he’s dead wrong about the resources. It costs the taxpayer $100,000 a year to keep someone in prison. After 35 years, the Department has already spent $3.5 million just locking him up. If he lives another ten years and spends most of that in prison, Corrections will spend another $1 million on him before he dies. So you can’t tell me they haven’t got the resources to help him – it’s the system that’s insane, not Mr Xxx.

Prison deaths linked to Corrections refusal to employ sufficient doctors

Three former prison doctors recently called for an inquiry into prison medical services after the death of two inmates at the Otago prison. In September, the Southland Times expressed concerns about the high suicide rate in prison: Jail health and suicide inquiry demanded. These stories follow allegations that the Corrections Department discourages prison doctors from prescribing pain killers and other essential medication, that it pushes doctors into breaching their medical ethics and operates a ‘minimum services dental policy’ leaving hundreds of prisoners in pain. On this blog, it has been argued that these policies constitute deliberate ‘negligence by government officials’ and are a form of pharmacological torture.

I have now discovered that at the core of this negligence, there is a major shortage of doctors and dentists in prison. This shortage pushes nurses into the role of gatekeepers – deciding who can and who can’t see the doctor.[i]

The United Nations Minimum Rules for prisoners

Theoretically, getting to see a doctor in prison should be easy. The United Nations Standard Minimum Rules for the Treatment of Prisoners state that:

“At every institution (i.e. Prison) there shall be available the services of at least one qualified medical officer…” and “The medical officer shall have the care of the physical and mental health of the prisoners and should daily see all sick prisoners, all who complain of illness, and any prisoner to whom his attention is specially directed.“

This rule is indirectly endorsed by Section 75 of the Corrections Act 2004 which states that prisoners are entitled to receive a standard of medical care which is “reasonably equivalent” to that which is available in the community. In a nutshell, these rules suggest that a medical officer (i.e. doctor) should be available to prisoners seven days a week – as is the case in the community where patients can visit their GP Monday to Friday and use an after hours’ service on the weekends.

To see whether Corrections is meetings its statutory obligations, I made an OIA asking how many hours a week doctors were on duty in each prison. I received a reply from Bronwyn Donaldson, Director of Offender Health, containing this chart which shows the number of hours that doctors are contracted to work at every prison in the country. It looks pretty much like this (below) except that it contains the figures for all 17 prisons:

Prison	Doctor contracted hours	Number of doctors	No of prisoners
Auckland prison	18 hours	3 Part-time	681
Mt Eden	28 hours	3 Part-time	996
Springhill	18 hours	1 Part-time	1050
Hawkes Bay	10 hours	1 Part-time	666
Rimutaka	28.5 hours	4 Part-time	942
Christchurch	24 hours	2 Part-time	926
Otago	10 hours	2 Part-time	485
Invercargill	2.5 hours	1 Part-time	180

The first thing to notice is that there is not a single prison in the country where a doctor is on duty for five days in the week, let alone seven. The greatest number of hours a doctor is available is 28 (or 3½ days) – at Rimutaka and Mt Eden – each of which has about 1,000 prisoners. The lowest number is 2½ hours a week – at Invercargill – which has 180 prisoners. No wonder prisoners complain that nurses often prevent them from seeing the doctor – most of the time there isn’t one on duty.

The ratio of doctors to prisoners

In order for there to be an ‘equivalent’ level of care in prison, the ratio of doctors to prisoners has to be similar to the ratio of doctors available to the general public. 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. In June 2013, the prison population was 8,597. The total number of hours worked in one week by all prison doctors combined is 229 – equivalent to 5.7 doctors working 40 hours a week. This represents an average (over all 17 prisons) of one doctor per 1505 prisoners. In other words, prison doctors have to service nearly five times as many patients as doctors in the community.

In some prisons, the ratio is even worse than that. Hawkes Bay prison holds 666 prisoners but has a doctor on duty for only 10 hours a week. That gives a (full-time) ratio of one doctor per 2,664 prisoners. Tongariro/Rangipo holds 540 prisoners but the Department has allocated a doctor for only seven hours a week. That gives a (full-time) ratio of one doctor per 3,085 prisoners.[ii] That doctor has to take care of nearly ten times as many patients as a doctor in the community.

The high health needs of prisoners

Michael Tyrrell handcuffed to his hospital bed the day before he died. His daughter took the photo

These are disturbing figures – but they represent only half the picture. This is because prisoners have much higher health needs than the general population. In the words of the National Health Committee: “A special case of health need exists in prison.” (iii) In support of this statement, the NHC reports that the lifetime prevalence of alcohol abuse and dependence among men in prison is twice that of men in the wider population. The lifetime prevalence of drug disorders is eight times higher. Historically, smoking rates among prisoners have been nearly three times higher for men and four times higher for women – although these figures may improve with the recent ban on cigarettes in prison.

The rate of heart disease among male prisoners is 3.3 times higher than males in the community while female prisoners have twice the rate of asthma compared with women in the community. Rates for hepatitis C among prisoners are also much higher – 8.1% for women and 5.8% for men compared with only 0.3% in the general population.

In regard to mental illness, the prevalence of schizophrenia among prisoners is more than three time the community rate; rates of post-traumatic stress disorder are four times higher for women and five times higher for men. Australian research suggests up to 30% of those in prison have intellectual disabilities and 50% are affected by a psychiatric disorder. The figures are likely to be similar in New Zealand.

How many doctors are required for equivalence?

In other words, prisoners have more medical problems, more complex problems, and a much greater need for medical services than the general populace. This means that providing the same doctor/patient ratio in prison as in the community would not actually provide an equivalent standard of care. In order to receive equivalent care, the prison population appears to need at least twice as many doctors per person.

The Royal New Zealand College of General Practitioners (which has been accused of sweeping prison suicides under the Cornerstone) believes that a ratio of one (full-time) doctor to 1000 patients “presents the best working environment for GPs”. At that level, prisoners might receive a standard of care which is superficially ‘equivalent’. Given the extraordinary high health needs of those in prison, the ratio would probably need to be one doctor per 500 prisoners before it could be called ‘reasonably equivalent’. In that case there would need to be 17 full time doctors available rather than the current 5.7.

Systemic breaches of the Crimes Act

In conclusion, it seems blatantly obvious that the Corrections Department is not providing anywhere near an equivalent level of care to prisoners and is therefore in breach of section 75 of the Corrections Act. Unfortunately, this doesn’t seem to be a crime. However, breaching section 151 of the Crimes Act is. The Crimes Act requires anyone who has vulnerable individuals in their care:

(a) to provide that person with necessaries; and

(b) to take reasonable steps to protect that person from injury.”

Basic medical care is absolutely necessary. Failing to employ sufficient doctors to provide this means health problems may be left unattended leading to unnecessary pain and suffering, sometimes with fatal consequences. The death of Jai Davis and suicide of Richard Barriball in the Otago prison two years ago are a direct result of the Department’s failure to provide medical necessaries. Although the police showed no interest at the time, after I made a formal complaint to the IPCA, the police finally began investigating these two deaths at the start of 2013. The investigation is on-going and no one in Corrections has yet been charged with a crime. Even if someone is, unless the Department doubles or trebles the number of doctors, prisoners will continue to die because of medical neglect.

Management at Corrections clearly don’t care. In her reply to my OIA, Bronwyn Donaldson, Director of Offender Health, said:

“I can advise that the Department has contracted sufficient hours for doctors to provide care to prisoners…the Department does not have any concerns about the hours currently worked in its prisons.”

[i] The difficulties prisoners experience accessing a prison doctor have been documented by the Ombudsman in his Investigation of the Department of Corrections in relation to the Provision, Access and Availability of Prisoner Health Services. The negative impact this has on the relationship between nurses and prisoners is described by Dr Michael Roguski in The Effects of Imprisonment on Inmates’ Health and Wellbeing.

[ii] The Ministry of Health says that when a doctor has more than 2000 patients, this is an ‘alert’ level indicating risk for the doctor as well as the patients.

[iii] Health in Justice, Improving the health of prisoners and their families and whānau, p 24-25.

Health & Disability Commission endorses inhumane treatment of prisoners

No one would be surprised to hear that standover tactics, bullying and violence are rife in prison. But you may be surprised to learn that prison nurses in New Zealand also engage in this kind of behaviour. In 2006, management at Corrections were so concerned about bullying by prison nurses, they asked the Health & Disability Commission to investigate.

The HDC dispatched two employees, Dr Elizabeth Finn and Mr David Webber to conduct a series of workshops in prison health centres. The first was held at the Waikeria prison in 2006 and workshops were subsequently held in another 12 prisons.

In 2008, a damning summary of the HDC’s findings was released in a report titled “Team development workshops for prisons nursing services delivered by Dr Elizabeth Finn and Mr David Webber“. In September 2009, a copy of the report was sent to the Ombudsman by HDC chief legal advisor, Nicola Sladden, describing a “culture of horizontal violence and bullying” within prison health centres. It identified the following problems:

Lack of leadership

“Not all nursing teams had a team leader, and not all of those that had a team leader experienced team leadership… Many teams identified a lack of cohesion in coordination with the team; this appears to occur in the presence of a team leader as well is in its absence.”

“Workshop discussions often identified situations where inadequacies in team operation actually or potentially compromise the care of patients and/or safety of members of the nursing team… ”

“There is great variation throughout the country (in team morale/culture). In some teams it was excellent and the team obviously was open, respectful and vibrant. In other teams this was identified as being very poor, to the extent that some nurses felt disinclined to come to work. Team culture was characterised by negative attitudes and interactions among nurses, (including) in-fighting, unkindness, backstabbing, and actions intended to discredit colleagues.”

“Some nurses experience treatment from custodial officers which shows no respect for them personally or for their role in delivering healthcare. Some nurses speak of having to ‘serve an apprenticeship’ of up to two years before custodial officers will accept them – speak to or respond to them. Some officers may interfere in discussions between a nurse and a patient, possibly ‘winding up’ the patient and making delivery of care more difficult.”

Discouraged medication policy

Another failing identified by Finn and Webber concerned the prescribing of medication by prison doctors. The authors wrote:

“It appears that some doctors are not sufficiently aware of the context of the prison environment and the particular challenges it presents. For example, some medications are inappropriate in this environment because of their potential for use as ‘currency’. Lack of national consistency with respect to provision of medications to patients who are prisoners may lead to stand-over tactics and abuse directed towards doctors in the first instance, and also towards nurses. A robust induction programme for doctors would be helpful.”

From time to time, prisoners have to be taken to hospital with serious injuries or medical problems. Finn and Webber even reprimand doctors in hospital Emergency Departments – apparently for not doing what they are told by prison nurses. The report says:

“(Doctors in) EDs may not be co-operating with advice from nurses that certain medications are not allowable in prisons, and are still prescribing these (codeine, morphine).”

In cases of severe pain, opiates such as codeine and morphine are likely to be the medications of choice. But the HDC seems to believe that, even in medical emergencies, prisoners should not have their pain relieved. Apparently they should continue to suffer – even when the pain is so bad they need to be taken to hospital.

Unfortunately, this ‘discouraged medication policy’ extends well beyond opiate pain relief. All medications including antidepressants and antipsychotic drugs are taken away from prisoners – usually on their first day in prison. Although this practice varies from one prison to another, often such medications are never reinstated.

Breach of human rights and medical ethics

Denying patients clinically appropriate medication, especially when they are in severe pain or have mental health disorders, is inhumane and a breach of human rights. It contributes to depression and even to suicide. The reality is that the systematic denial of opiates and other clinically appropriate medication is a form of pharmacological or ‘clean’ torture; it causes serious harm and distress to the prisoner without leaving any visible evidence.

The policy also encourages prison doctors to breach their medical ethics. The New Zealand Code requires physicians to “Consider the health and well-being of the patient to be your first priority” and to “render medical service to that person without discrimination.” When doctors are coerced into making prison policy their first priority, and discriminate against the patient because he or she is in prison, they risk being struck off for breaching their ethics.

What’s extraordinary is that the Health and Disability Commission seems to condone this practice. For a Government agency with responsibility for promoting safe medical practices, this is truly disturbing. It suggests the HDC is complicit in Corrections strategy to breach the human rights of prisoners and raises serious questions about the integrity of investigations into complaints by prisoners who need these medications.

The Commissioner’s response

In July this year, I wrote to the HDC and asked if they still endorse this ‘discouraged medication policy’. Mr Anthony Hill, the Commissioner, replied:

“It is not HDC’s practice to endorse the policies or procedures of health care providers. This is because I must consider complaints to HDC fairly, with an open mind and free from bias. This may be called into question if I have previously endorsed a policy or procedure that is the subject of a complaint to HDC.”

That’s the whole point. The Finn Webber report is quite clearly an endorsement of Corrections discouraged medication policy and my letter therefore questions the integrity of all HDC investigations into prisoner healthcare in the last five years. Since Mr Hill refused to acknowledge the bias in the HDC’s position, I have now written to the Ombudsman suggesting that if the HDC does not endorse this particular policy, then the Ombudsman should encourage the Commissioner to write to Corrections and tell them so. Otherwise, the Finn Webber report gives the Department every reason to continue medication off prisoners – thereby leaving them in pain and distress – and believing the HDC endorses this unethical practice.

I also suggested to the Ombudsman that he/she should persuade the Corrections Department to change this practice and remove it from their Medicines Policy. This is because New Zealand is party to the Convention against Torture and Cruel, Inhuman or Degrading Treatment or Punishment which requires Governments to take effective measures to prevent the torture and ill treatment of people who are detained by the State. And since 2007, when New Zealand signed the Optional Protocol to the Convention against Torture (OPCAT), the Ombudsman became one of the monitoring bodies with responsibility to ensure that New Zealand meets its obligations under the Convention. If he does not intervene, then by failing to act, the Ombudsman is also condoning and endorsing the torture and ill treatment of New Zealand prisoners.

Corrections’ discouraged medication policy amounts to phamacological torture

On Tuesday, 1st October 2013, Geoff Robinson (photo) interviewed Roger Brooking on Morning Report about the Corrections Departments Medicine Policy. It runs for 4.30 minutes. This is the full transcript of the interview:

Geoff Robinson: Some doctors are calling for a major review of the way prisoners’ health is managed. Dr Wayne Cunningham, a former Otago prison doctor says the emphasis on security over health when he worked at the prison meant it didn’t work well. And he says it was a miracle no one died on his watch. Last week, Radio New Zealand revealed that the police are investigating accusations that a prisoner received substandard care at the Otago prison before he died in February 2011 and they’re reviewing another patient’s suicide four months earlier. Those investigations are underway after a complaint from a Wellington drug and alcohol counsellor, Roger Brooking, and he joins us now.

So this suggestion from Dr Wayne Cunningham that there should that there should be a review of the whole health needs of prisoners and how they dealt with, would you agree with that?

Roger Brooking: I absolutely would. The Corrections Department has a number of policies and practices which make it very hard for doctors and nurses in the prison system to provide what I would call proper or equivalent health care (to that which is available in the community). One of the policies that the Department has is the Medicines Policy. It has a particular section, 6.1, which I refer to as the “discouraged medication policy”. Basically what that says is that prison doctors are “actively discouraged” from prescribing benzodiazepines, opiate painkillers, and any other medication which may be tradable or have currency in the prison environment.

Geoff Robinson: these are medications which are normally provided to patients by the health service throughout the country but doctors in prison are actively discouraged from prescribing them?

Roger Brooking: That’s right. And this has significant impacts on the prisoners. There are violent incidents in prison; prisoners like anyone else get sick; occasionally they have to go to emergency departments – the policy even extends to the point that doctors in hospital emergency departments are discouraged from prescribing opiates to a patient, a prisoner, who may have broken his leg or been stabbed or whatever it is. To me, I regard this as a kind of enhanced pharmacological torture.

Geoff Robinson: Is it a question then of whether the prisoner or the patient has the drugs in his or her possession and is able to take them as appropriate and may possibly try and trade them to some other prisoner – or is it something that the prison authorities could hand out as necessary?

Roger Brooking: Well, that’s exactly how they do it. They don’t give the prisoner a handful of pills or a bottle or a little box like you would get in the community; in the prison environment, especially for medications like opiates, those are dispensed in my understanding on a daily basis. The prisoner has to go to the prison health centre and the nurse would give him the pill and he has to swallow it in front of the nurse. And so I don’t see that there’s too much of a problem there.

Geoff Robinson: And so you believe therefore that prison doctors should not be actively discouraged from prescribing them because there’s enough safeguards in the system to prevent them being traded?

Roger Brooking: Yes. And I would also add that this policy encourages prison doctors to actually breach their medical ethics. Because prison doctors, like any other doctor, his first priority is to provide a duty of care to the patient. Now if the doctor basically gives in to this ‘discouraged medication policy’ and doesn’t give the prisoner medication which is clinically appropriate in that particular situation, then he is breaching his medical ethics – and could be struck off.

Geoff Robinson: So the doctor is paid by the Corrections Department to provide care to the prisoner?

Roger Brooking: Yes.

Geoff Robinson: And the doctor’s first responsibility is to the patient, the prisoner, rather than the person who’s paying him?

Roger Brooking: Under his medical ethics, yes, his responsibility is to the patient. But what appears to happen is that in the prison environment, because doctors and nurses are contracted to the Corrections Department that interferes with the patient doctor relationship. And in many cases from my experience, many doctors find this very difficult. I think it is a difficult situation for them because they’re caught between a rock and a hard place and it depends on the integrity of the doctor. Some doctors will put the patient first; some doctors will put the prison policies first.

Geoff Robinson: Thank you for joining us. That’s Roger Brooking. He’s a Wellington drug and alcohol counsellor.

“It’s a miracle no one died” – three former prison doctors call for review of prison health services

RNZ’s Morning Report has just interviewed three prison doctors who all say a review of prison health services is needed. Here’s a link to the story. The full transcript follows.

Geoff Robinson: A former Otago prison doctor who is critical of the way health services are provided in prison says a major review is needed. Last week, Radio New Zealand revealed that the police are investigating allegations that a prisoner received substandard care at the Otago prison before he died in February 2011. They’re also reviewing another prisoner’s suicide four months earlier. Dr Wayne Cunningham says prison administrators are experts in security and not health, and something has to change. Here’s our Otago reporter, Ian Telfer:

Ian Telfer: Wayne Cunningham’s a GP who teaches at the Otago University Medical School. He took a part-time contract as prison doctor at the Otago Corrections Facility near Milton on the day it opened in 2007. Dr Cunningham said he’d never done the job before and had to wise up quickly to the prisoners and the prison service. But he says he and another doctor gave up their contracts after three years in 2010 because it was getting too risky.

Dr Cunningham: “The most confronting stuff is around detoxification, where prisoners would come in, especially alcoholics, who were sometimes consuming enormous amount of alcohol (before they came to prison). They need to detox – but facilities to detox safely in prison are very limited, well, they were certainly limited when we were working there.”

Ian Telfer: “And you were concerned people could die?”

Dr Cunningham: “Absolutely. There were some occasions when it was almost miraculous that nobody died while we were looking after them.”

Ian Telfer: The two deaths under police investigation happened just a few months after Dr Cunningham left the prison – one a suicide and the other involving drugs. Dr Cunningham says when he was at the prison, there was no facility to provide nursing care right through the night as would happen in hospital. He said there were times when the level of care was not the same as that provided in the general community. Dr Cunningham says in Britain, prisoner care was shifted to the Health Ministry about a decade ago – and it is time for a major review to look at doing the same thing in New Zealand.

Dr Cunningham: “The Department of Corrections has expertise in the management of custody. The Ministry of Health has expertise in the delivery of health care. I think that’s the organisation which should have responsibility for delivering health care in prisons.”

Ian Telfer: Dr Cunningham’s colleague at Otago prison was Dr Richard Simpson. Dr Simpson says they felt they worked for Corrections first and as doctors second – and that meant they could not always carry out ‘best practice’.

A former prison doctor who worked at three Christchurch jails for several years, but won’t be identified, is backing the call for a review. He says he left the prisons after unsuccessfully pushing for a national clinical director position to bring in more medical expertise and reduce the isolation and risks for (prison) doctors.

Unidentified Christchurch prison doctor: “Medico-legally, prisons are quite a risky place to work and so the longer you work there, the more likely you are going to end up in front of the health and disability commission or a coroner’s Court. It is a very fatiguing kind of job and, to do it day in and day out, you just cannot do it forever.”

Ian Telfer: But the Corrections Department says there is no problem with the health service that needs fixing. Its Director of Offender Health, Bromwyn Donaldson, said the service looks after thousands of inmates. She says events like the two deaths at Otago prison are upsetting – but are not typical and are being taken out of context.

Bronwyn Donaldson: “We have a lot of policies and procedures; we have the Cornerstone accreditation process which looks at those policies and procedures; we have audits of the health services delivered; we have complaint mechanisms, and customer satisfaction surveys. All the evidence I have in front of me gives me no cause for concern.”

Ian Telfer: Bronwyn Donaldson says there are many agencies watching prisoner health and it already gets enough scrutiny.

Geoff Robinson: Corrections Minister, Anne Tolley, declined our interview request but gave us this statement which said: “Corrections has a duty of care to prisoners which it takes very seriously. Staff always have to be mindful of safety and security; they are often dealing with high risk and high security prisoners.”

Otago prisoner crippled by lack of medical treatment

A few months ago, Whenu Knight was a prisoner in Otago. He tore his archilles tendon playing touch rugby and now he can hardly walk. Here’s the video link about his shoddy medical treatment on TV3. Here’s the same story on RNZ’s Checkpoint.

This story follows the publication of the far more tragic story about Richard Barriball, who died in Otago prison in September 2010, and Jai Davis who died four months later – both because of poor medical treatment. See Otago prisoner death investigated.

Olive McCrae, advocate for Mr Knight, wants anyone else who has a similar story about inadequate medical treatment in Otago prison to contact her. She says:

“I encourage all other people with similar experiences to contact me at olive dot mcrae at gmail dot com. We are building a case of people’s stories for a more indepth look at this important issue.”

Here’s the hard copy from TV3:

A Dunedin man says he was forced to hobble around Otago’s Milton Prison with a ruptured Achilles tendon after being denied adequate medical attention. Whenu Knight says prison medical staff told him it was just a sprain and to take painkillers, but he’s now facing major reconstructive surgery.

Limping about is not Knight’s usual style, but since rupturing his Achilles in July, he’s had no choice. Knight instantly knew he’d done some serious damage playing touch in Otago’s Milton Prison, but nurses diagnosed a sprain. He claims it was five days before he saw a doctor.

“I went in to see the doctor and the doctor also said it was just a sprain and there was nothing to it and to keep taking my Panadols,” he says. Four weeks later he was released and took himself straight to his GP. “The doctor had a look at it and straight away said, ‘This is a ruptured Achilles tendon.’ There’s a huge deficit there.”

Medical records show he has a neglected Achilles rupture, which requires major reconstructive surgery because the delayed primary treatment was ruled out. Sports physician, Dr Mark Fulcher, says “The tendon will heal, but it will heal long and often you will have a loss of power and loss of ability to push off on your leg.”

Knight’s spent more time in New Zealand’s prisons than out. He rates the healthcare in Milton as the worst in the country. “We’re human beings,” he says. “We’re treated like cattle. We’re treated like numbers. They don’t even look us eyeball to eyeball. It’s just, ‘What’s your symptoms? What you got? Okay here’s a Panadol.’ We’re treated like cattle in there. We’re human beings. They don’t even look us in the eye.”

His complaints come hot on the heels of a police investigation into the deaths of two other inmates who died in Milton Prison. While the Corrections Department says it won’t discuss individual cases. Knight hopes that by speaking out he might help improve conditions for inmates still in there.

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:

“Prisoners have high dental health needs, possibly caused by increased levels of neglect of oral care, high rates of substance abuse, smoking and underlying poor nutrition. Prisoners vary in their ability and motivation to take care of their own oral health, often entering prison with a previously chaotic lifestyle. “

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:

Last year I filled in a form in July. I didn’t get seen till just before Christmas. But by then I’d already pulled it out myself. They’d given me Panadol and cloves, but that was no good. It was too painful. I couldn’t eat I was in so much pain. I was losing weight. I’ve pulled three out myself so far. (Timaiti, Māori man, 40–50 years)

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.

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.