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.

Torture image

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 demandedMedical ethics for dummiesThese 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

cellNo 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 ethicsPrison doc

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 RobinsonGeoff 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?

Pill in mouth

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

Dental tortureWhen 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.