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.

Torture in New Zealand 1 – the so-called At Risk cells

In 2009 Dr Michael Roguski and Fleur Chauvel interviewed 63 New Zealand prisoners chosen at random asking questions about their treatment in prison. In a report titled The Effects of Imprisonment on Inmates and their Families Health and Wellbeing, the researchers document a number of inhumane and degrading practices which cause intense psychological suffering; these produce the same level of trauma as physical torture techniques.

These inhumane practices are part of daily life in New Zealand prisons.  One of the most abusive is the use of ‘At Risk’ cells. These are special observation cells for potentially suicidal prisoners.  The prisoner’s clothes and underwear are taken away and replaced with a ‘suicide proof’ canvas tunic. There’s no TV, no radio, nothing to read and no visitors are allowed.  The prisoner is locked up in a small cell 23 hours a day – with one hour for exercise in a slightly bigger cell. The camera is on 24 hours a day, and the lights come on at night every 15 minutes so officers can check that the prisoner is still alive – although sometimes they don’t check and the prisoner still dies.

Sleep deprivation

Perhaps the most inhumane feature of these At Risk cells is the lights turning on and off so the prisoner can’t sleep. So if he wasn’t suicidal when he came in, he soon will be.  Keeping someone awake for days on end causes a range of physiological symptoms  including headaches, anxiety and impaired cognitive functioning. It also causes high blood pressure and cardiovascular disease, and can lead to depression, hallucinations and psychosis.  The effects are so debilitating, the United States uses sleep deprivation to torture prisoners at Guantanamo.

Placing a prisoner who is already disturbed into a cell where he is unable to sleep is about as barbaric as it gets. And yet this is exactly what the Department did with Antonie Dixon who has a long history of mental illness. He was in the At Risk cells for months before he finally killed himself.  He covered up the camera with toilet paper and somehow managed to hang himself with a rope made out of the ‘suicide proof’ canvas tunic.

Dixon should have been in a psychiatric hospital where he could receive proper psychiatric treatment.  The fact that he managed to commit suicide after months and months in an At Risk cell highlights the pain and suffering he experienced.  Even if Corrections didn’t physically torture him, psychological torture produces the same trauma as physical techniques. What happened to Dixon was torture – pure and simple.

Fear of going to At Risk

Dixon’s case is one of the worst. But out of the 63 prisoners that Roguski and Chauvel interviewed, nearly half had been diagnosed with a psychiatric condition prior to their incarceration.  Bearing in mind, the suicide rate in New Zealand prisons is 11 times higher than in the community. And on any given day, 20% of New Zealand prisoners are ‘thinking a lot’ about killing themselves.  That’s about 1,700 prisoners who are potentially suicidal on a daily basis – out of a total of 8,500. Dr Roguski says these prisoners are so afraid of going to At Risk, they often refuse to ask for help.  He wrote:

“Participants (in the research) who were experiencing depression and suicidal ideation made decisions not to seek intervention for fear of being placed in the At Risk unit.”

It gets worse. These At Risk cells are not just reserved for the suicidal.  The Department also uses them for prisoners who are merely upset or tearful.  One man in Roguski’s study described how he ended up in At Risk:

“When I came from the court house it was close to midnight ’cause I was waiting all day for a verdict. Then I come in, got strip searched and everything, and then they go to me, “Are you alright? “ “Yeah I’m alright.” But I had a bit of a tear in my eye because I was thinking about my kids. Then they go, “How about we just put you on observations for the night?”

They were like, “Don’t worry you will just be here for the night until we sort it out”. One night turned into three weeks and I told them every day, “Mister can I go back to remand?” … “Yeah, hang on we’ll sort it out.” Three weeks later I was still in At Risk… I was going nuts.”  (Anaru, Māori man, 18–25 years)

Some prisoners have spent months in these appalling conditions. In response to an Official Information Act request, the Department advised that in 2011, over 3,000 prisoners were placed in these At Risk cells. That’s more than one third of the entire prison population. One prisoner spent almost an entire year in one – 349 days to be precise.  Maria McDonald, Assistant General Manager, Prison Services who replied to my OIA thought this was totally justified. She claimed this occurred because:

“The prisoner may not have presented with a treatable mental illness and forensic treatment may not have been identified as the appropriate form of clinical management.”

Yeah right!   Based on his research, Dr Roguski came to an entirely different conclusion about the use of these cells.  He wrote:

“It was generally felt that officers, and some medical staff, automatically channelled prisoners into At Risk, or left them there for inappropriate amounts of time, due to lack of training and a limited availability of medical professionals to deal with possible mental health crises. As a result, participants related that if prisoners appeared to be emotional then they would be placed in an At Risk cell.”

According to the Ombudsman“Prisoners will often drift in and out of At Risk Units, whether they are at risk of self-harm or not.”

The reality is that officers can only channel prisoners into At Risk if a prison nurse gives their permission and signs the appropriate form. In other words, its prison nurses, rather than the officers, who are endorsing the use of these torture cells.  What’s truly remarkable is that before publication, Dr Roguski showed his report to Corrections management to obtain their feedback. He said he was quite surprised they didn’t disagree or express an objection to any of his findings.

Dead prisoners don’t complain about their medical treatment

In April 2013, the Dominion Post ran a story about the appalling medical treatment in prison of Stephen McMurtrie.  McMurtrie injured his shoulder working out in the prison yard. He was sent to hospital for an x-ray where he was told he would need an operation. They gave him opiate pain medication (tramadol) and told to come back for the operation in a month.

No you can’t have pain relief

Corrections management doesn’t like prisoners having opiates – no matter how much pain they’re in. They even made up a ‘Medicines Policy’ to discourage prison doctors from prescribing opiates, benzodiazepines and other drugs with potential for abuse. So when Mr McMurtrie returned to prison, the prison doctor took him off the tramadol and replaced it with voltaren and ibuprofen.

Over the next five days, Mr McMurtrie became increasingly unwell. The nurses ignored him. Eventually a prison officer took him to see the prison doctor.  When he got there, he vomited up a couple of litres of blood and collapsed on the floor. The doctor called an ambulance and Mr McMurtrie was taken to hospital in a coma. He spent two weeks in intensive care and nearly died. He was handcuffed to an officer for the entire two weeks – even though he was unconscious. Altogether, he spent five weeks in hospital before he was well enough to go back to prison.

Voltaren is known to cause gastrointestinal bleeding in some patients. It should not be taken by patients with liver cirrhosis, ulcers, or an infection. Mr McMurtrie had all three of these conditions. Three months later, Mr McMurtrie is still not able to walk properly and is now in a significantly reduced state of health.

No you can’t have another mattress

Here’s another tragic case. William Allen is 44 years old and was sent to prison for possession of cannabis. When he was 19, his ankle was crushed when he was run over by a truck. It never healed properly and since then Mr Allen has had over 50 operations on his leg. It took seven years before the leg was strong enough so that he could walk again. His most recent operation was in 2012, one week before he was sentenced to prison on his current offending.  Surgeons cut the leg open and put antibiotic pellets inside the bone.  He was on an antibiotic drip for a week afterwards and the dressings had to be changed every day.  He was given morphine to cope with the pain.

He was sentenced to prison the day after he was discharged from hospital.  Once in prison, nursing staff didn’t bother to change the dressings on his wounds as required; it began to smell, increasing the risk of external infection, on top of the internal bone infection. Mr Allen gets only half the pain medication he is allowed; the medication that he does receive is given to him too early in the day with the result that he gets pain at night and doesn’t get much sleep. He can’t even get comfortable. He sleeps on a mattress which is only two inches thick – on a concrete base. He asked for a second mattress to provide some relief – but that was denied. It seems prison management want him to suffer.

Mr Allen has also missed follow-up appointments with infection specialists  in the community because prison staff are  too busy to take him – or just don’t care. After 12 months in prison, he is still on two different antibiotics. If the infection spreads, he could die.  His leg is permanently twisted and he has been told he needs yet another operation so he is thinking about having the leg amputated instead. Mr Allen wrote a letter of complaint to the Health & Disability Commission – but the prison opened it up, didn’t like what he wrote and never sent it.

Complaints up by over 60%

Potentially there are three agencies prisoners can complain to about their medical treatment in prison – the Corrections Inspectorate, the Health & Disability Commission or the Ombudsman. There’s not much point in complaining to Corrections Inspectors. In 2012 the Department’s Annual Report showed that very few complaints were made to the Inspectorate about prison health services.  Of those that were made, not one was found to be ‘justified’. The obvious conclusion is that prisoners complain to external agencies rather than complain to the Inspectorate because they know the Inspectorate will not investigate their complaints properly.

I wrote to the Health & Disability Commission asking how many complaints they receive from prisoners each year – but they claimed they don’t keep records on that. The Ombudsman was more helpful. In 2011 the Ombudsman received 259 complaints about prison health services. In 2012, there were 418 complaints – up 62% in just one year. Of course these complaints come from the prisoners that are still alive. They ones that die don’t bother and since 2008, 75 prisoners have died. Not surprisingly, not one of them made a complaint about their medical treatment.

Diabetic dying to get out of prison

Jane Wilson is 36 year old drug addict. She was referred to me for an alcohol and drug assessment after being charged with possession of methamphetamine for supply.   She started using meth about ten years ago and began selling to friends and acquaintances to fund her habit.  She had also been smoking cannabis since she was 14 – usually on a daily basis.  I interviewed her in July 2012 in Arohata prison – by which time she had been on remand for three months as her case slowly winds its way through the courts.

This is not an uncommon story – except that Ms Wilson has diabetes, diagnosed at the age of 11. So for 25 years she has been injecting herself with insulin on a daily basis and usually requires five injections a day.

Diabetes requires careful management.  Diabetics are supposed to test their blood sugar levels four or five times a day in order to know how much insulin to inject. A normal reading is between 4.00 and 7.00 mmol. Readings below 4.00mmol are potentially dangerous as the brain is being starved of oxygen – a condition known as hypoglycaemia. The patient becomes weak, anxious and confused and if the blood sugar level continues to drop, they may become comatose and die.

Diabetics generally carry barley sugars or something sweet to give their sugar level a rapid boost if it drops too low.  Soon after arriving in Arohata, Ms Wilson was given a supply of glucose tablets and the prison nurse gave instructions that she was to have these with her ‘at all times’. The nurse then went on leave for eight weeks. Apparently believing that inmates cannot be trusted, even with glucose, prison officers took the tablets off her and kept them in the office. So whenever her blood sugar tested low, Ms Wilson had to press the emergency button in her cell and ask for help.

These requests were met with a variety of unhelpful or insulting responses such as:  “I hope you’re not cunting us around Wilson.”  On another occasion when her blood sugar was down to 2.4mmol, an officer said: “We can’t be doing this every night Wilson.” On yet another occasion, about half an hour before dinner was due to be served, her blood sugar dropped to 3.4mmol. She pressed the buzzer twice and was ignored twice. She had to ask the officer who brought the dinner to give her some sugar as well.  Next day Ms Wilson told a nurse what had happened and was assured the officers would be spoken to.  Later that day, a male guard said: “We don’t appreciate being complained about so don’t be expecting any favours.” Another officer told her: “It’s not all about you Wilson.”

In the report which I provided to the judge, I pointed out that this situation was making Ms Wilson very anxious. She was so upset she cried virtually every day, and became so depressed she needed antidepressants. She was afraid she might die from a hypoglycaemic attack because the prison officers just didn’t care. In my report I wrote:

1)      Ms Wilson’s situation is complicated by diabetes. Her concerns about the quality of care she currently receives significantly exacerbate her underlying anxiety.  Ms Wilson worries that she might die in prison because prison staff either don’t care or don’t know how to assist her regulate her blood sugar levels – especially at night when medical staff are not available. 

 2)       Corrections Department rules make it difficult for Ms Wilson to gain effective control of her blood sugar levels. I spoke to the specialist diabetic nurse (at Kenepuru Hospital) who expressed particular concern about the last meal of the day in prison being served at 4:30 p.m. She said that to maintain control of their blood sugar levels, diabetics need to eat six meals a day and need supper before going to bed in order to avoid developing low blood sugar during the night. She said that ‘low blood sugar is an extremely dangerous condition’ for Ms Wilson.  

 3)      In a recent report on the health of prisoners, the Ombudsman reported that: “Prisoners continue to complain that the national menus implemented by the Department do not consider the specific health needs of prisoners, especially diabetics.” Ms Wilson’s GP and the specialist diabetes nurse both expressed concern about the fatty prison food which is not good for diabetics.  They both felt that the prison regime with limited physical activity makes it even more difficult for a diabetic to manage blood sugar levels which require an appropriate balance between food intake and physical activity.

After nearly four months on remand, numerous hypoglycaemic attacks and one emergency visit to hospital, Ms Wilson eventually appeared in Court. The judge showed compassion and released her on electronic bail while her case proceeds. But if she receives a sentence of more than two years, she will have to go back to prison where she will be exposed to the same kind of treatment all over again.

The prison health system – maybe it’s not torture, but it hurts like hell

Section 5 of the Corrections Act requires that prisons are “operated in accordance with rules …  that are based on the United Nations Standard Minimum Rules for the Treatment of Prisoners.” However, in its report titled “Investigation of the Department of Corrections in relation to the Access and Availability of Prisoner Health Services”, the Ombudsman found numerous failings in the delivery of health services.  He also said the Corrections Department does not meet Article 22(1) of the UN Minimum Standard Rules – which requires every prison to have at least one qualified medical officer, who should also have some knowledge of psychiatry.

Mental torture

This rule appears to be breached by virtually every prison in the country. The Ombudsman found that “Many medical officers have limited training in psychiatry and… some prison healthcare teams had no mental health nurses to provide specialised care to those who fell beneath the threshold of severe and enduring illness.”

To put it bluntly – this is crazy.  More than half of prisoners have had mental health problems; 60% have a personality disorder; almost two thirds have had a serious head injury and 90% have a history of alcohol and drug abuse. But the level of psychiatric care in prison is minimal. In an interview with psychiatrist and Parole Board member, Dr Phillip Brinded, the Sunday Star Times reported that “If a prisoner is so psychotic they can’t be managed, they will join the ‘acute’ list and get to hospital within days, but those who are just quietly off their rocker can languish on the ‘sub-acute’ list for many months. It seems that in order to get treatment in prison, you have to go really mad.”

Dental torture

This is not the only UN Rule breached by the Corrections Department. For instance, Article 22 (3) states that “The services of a qualified dental officer shall be available to every prisoner.” That sounds reasonable.  Prisoners tend to have chronically poor oral health care and the Prisoner Health Survey (2005) found that one third of those interviewed reported having a toothache in the previous month.  However, Corrections has difficulty securing the services of dentists – presumably because the Department doesn’t pay dentists as much as they can earn in private practice. Because of recruitment difficulties, the Ombudsman reported that the Department has been flying a dentist from Wellington to Christchurch to provide dental care for prisoners at all three Canterbury prisons.

Even in those prisons where dentists are available, the waiting list is up to three months. But here’s the real toothache.  The Department has a “minimum dental services policy” whereby pain relief only is provided to most prisoners – which may include medication, extraction, or drainage of an abscess.  Early treatment with amalgam fillings – which would prevent further decay – is not provided. Now that’s really crazy.

But the pain gets worse. Prisoners near the end of their sentence are not eligible for any dental treatment at all – they just get medication. The Ombudsman gave case histories of prisoners who had severe tooth decay who were not allowed by prison nurses to even see the dentist. For some of these prisoners, the decay eventually turned into an abscess.  One prisoner reported that “his jaw ached, his glands were swollen, and he had a sore ear – and he couldn’t sleep.”  All he got was panadol and told to “see a dentist when you get out.” That may not be torture – but it sure as hell hurts – night and day – for months on end.

Lets ratchet up the screws 

The Ombudsman concluded his report with a recommendation that responsibility for the health care of prisoners should be removed from the Corrections Department entirely and given to the Ministry of Health. The MOH agrees. A study released by the Ministry in 2010 says “An inherent tension exists between a custodial role and the delivery of comprehensive, high quality health services… current institutional arrangements prevent medical professionals from fully exercising their duty of care.”

Corrections Minister, Anne Tolley, and chief executive, Ray Smith, are clearly unconcerned. They want to reduce, rather than increase, the role of medical professionals in prison. Legislation was introduced to Parliament in February giving nurses rather than medical officers (doctors) overall responsibility for the healthcare of prisoners.  Up till now, Medical Officers who are contracted to Corrections have been responsible. Being on contract, they have some independence and can make decisions based on ‘best practice’.  But prison nurses are employees not contractors  – they can be told what to do by prison managers who have no medical training whatsoever.

This legislation will increase the ‘inherent tension’ which already exists and further erode the standard of medical care in prison.  Some would say – but they’re all crims in there, so who cares?  No one in the Corrections Department, that’s for sure.  Their attitude seems to be – if we can’t torture them, let’s make sure they feel the pain.

The ritalin rules in prison

ADHD stands for attention hyperactivity disorder. Kids who’ve got it are either inattentive, hyperactive, impulsive or sometimes all three – and it affects between 3% and 5% of school age kids. As at July 2009, there were 760,859 children attending school in NZ which means somewhere between 23,000 and 38,000 children have the disorder.

According to a New Zealand support group, as many as two-thirds of children with ADHD have additional problems. 30-50% will have conduct disorder – a childhood behavioural problems which sometimes leads to anti-social personality disorder in adults.  20-25% of those with ADHD will have anxiety problems. Generally 20-30% of ADHD children also have learning problems and struggle to read and write.  For approximately 75% of those with ADHD their symptoms continue into adulthood, although levels of hyperactivity may decrease with age.

What causes it? It may be genetic. But whatever the cause, the majority of evidence suggests that in those with ADHD, the frontal cortex of the brain under-performs  leading to a loss of attention,  planning and impulse control. It responds to stimulant medications (including ritalin). Although ritalin is a stimulant, paradoxically it has a calming effect on people with ADHD. This is because it stimulates the frontal cortex which generally improves concentration and impulse control for the sufferer.

Dr Paul Taylor, a paediatrician in Nelson, estimates that about 43% of those who end up in  prison have ADHD.  That means in New Zealand prisons, there are currently about 3,700 prisoners who may benefit from ritalin or a similar medication.  In 2012 I made an official OIA inquiry to the Corrections Department asking how many prisoners were currently prescribed ritalin (or an equivalent). The answer was 17.

Risk factor for substance abuse and offending

When ADHD is not treated, it becomes a significant risk factor for substance abuse and criminal offending.  So treating it is especially important for those who end up in the justice system. When left untreated, prisoners with ADHD struggle to concentrate in rehabilitation programmes and may become disruptive.  This happened to Mr Chris Wills, an inmate in Mt Crawford prison, who I interviewed prior to his parole board hearing in 2012.  Mr Wills has a long-standing drug problem and for many years self-medicated his ADHD with methamphetamine (another well-known stimulant). Eventually he sought help from mental health services in the community and was prescribed ritalin. He ended up in prison shortly thereafter, and without consulting a doctor, prison management took him off it.

Sometimes prisoners’ behavioural problems become so bad, the prisoner ends up in 24 hour lock-up. This happened to Mr Kurt Winklemann  who was sent to prison for an assault in 2008; he had ADHD and was also denied ritalin when he got to prison.  His behaviour deteriorated and he ended up in the ‘management unit’ for difficult prisoners.  Rehabilitation programmes are not available in the management unit. To get into rehabilitation, you have to behave yourself first – without your medication.

Drugs of abuse

The Department generally justifies the denial of ritalin to prisoners on the grounds that it is a drug of abuse.  So is methadone.  But offenders who are sent to prison while on  methadone  still get  it  – because opiate addicts on methadone are less likely to re-offend when they get out.  In 2011, 89 prisoners were on methadone.  It’s dispensed in a controlled environment under strict supervision – and there is absolutely no reason why ritalin could not be dispensed in the same manner.

Inmates are also not generally allowed opiate based pain killers either – no matter how much pain they’re in. If a prisoner requires hospital treatment and is given morphine for pain relief,  once they return to prison, the morphine will be terminated.  This is because the Department regards opiates as drugs of abuse. So if a prisoner gets stabbed, has a broken leg, or a tooth removed, no matter how bad the pain is, probably all he will get is Panadol.

Back to the ‘ritalin rules’. On February 12, 2012 the Herald on Sunday ran a story about Mr Wells and Mr Winklemann.  Acting National health manager for the Corrections Department, Bronwyn Donaldson, was quoted as saying that “Ritalin was available for some prisoners. An alternative was given to inmates who are at risk of abusing the drug.”  Really? In 2010, there were 560 teenagers in New Zealand prisons and over half  have ADHD. In my work as an alcohol and drug counsellor, I have interviewed dozens of prisoners with this condition. Not one was on ritalin or any other medication.

Prisoners set up to fail

What this all means is that prisoners with ADHD  (and other mental health problems) are  set up to fail.  Not only does Mr Wills struggle to focus while attending rehabilitation  in prison, he also needs to attend a drug treatment program when he gets out. He comes up for parole shortly but two community-based treatment programs have already declined to accept him until he is stabilised on medication. Catch-22. Mr Wills is likely to relapse to methamphetamine or other drugs as soon as  he gets out.  He needs to be stabilised now – while he’s still in custody.

One more point. Appropriate medical treatment is a basic human right and the Department has a statutory obligation to provide it.  Section 75 of the Corrections Act 2004 states that: “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”.

By denying prisoners access to appropriate medication, not only does the Department set them up to fail,  it is also in breach of the Act.  The Department should get its Act together – and read the rules instead of making up its own.

Prisoner dies when guards too busy to help – the case of Anna Kingi

Eva BradleyIn November 2011, the Waiikato Times reported that a Hamilton woman died in prison of a heart condition after her calls for help were ignored by guards. An inquest into the death of Anna Selina Kingi, 41, at the Auckland Coroner’s Court heard that Ms Kingi was found dead in her cell at Auckland Regional Woman’s Facility (in 2008) more than an hour after she activated her alarm.  She was mother of seven children (see photo) and grandmother of one and had been in prison for just under a month when she died.

The inquest heard that Ms Kingi was scheduled to see a doctor the day before she died, but the doctor was too busy and did not see her.  When she became distressed the next day (November 10, 2008), Ms Kingi pressed the emergency alarm in her cell  but prison guards ignored the call. One guard, whose name was suppressed, said she heard the alarm, but was busy so she just asked through the intercom if Ms Kingi was alright.  There was no answer. So she ignored it, did not send anyone to check, did not record the call and did not refer it to the incoming shift.

A few minutes earlier, another guard who was supposed to visually check her cell, failed to do so.  Three minutes before Ms Kingi pressed her cell alarm, she walked past Ms Kingi’s cell without looking in. She told police that rather than look in the cells, she fastened her digital ID to a broom handle, reached up and swiped the card over a sensor to make it look like she had done her rounds.

Cardiologist Dr Jim Stewart told the inquest Ms Kingi died of hypertrophic cardiomyopathy – an inherited disorder that causes thickening of the heart, making it hard for the heart to pump blood. He said normally there was a lead-in tachycardia (rapid beating) when the disorder led to a fall in blood pressure.  He said defibrillation or CPR could have worked if performed  in the first five minutes after the alarm. When Ms Kingi’s body was discovered more than an hour later, it took 13 minutes to get the keys and open her cell.  The inquest was told that at the time the prison had only one defibrillator and custodial staff could not have accessed it anyway.

This story is typical of the quality of healthcare offered to prisoners.  It is not dissimilar to the case of Justin Rys who also has a heart condition and has sleep apnoea. Mr Rys has to wear an oxygen mask while he sleeps – otherwise he stops breathing during the night placing additional stress on his heart.

While Mr Rys was in Rimutaka prison on remand earlier this year, the machine which pumps the oxygen broke down. For two weeks, nursing staff ignored his pleas for help. It was only when his lawyer intervened that Mr Rys was taken to hospital and given a new oxygen pump. If it hadn’t been for his lawyer, My Rys might also have died in prison.  Prison guards and nursing staff at Rimutaka clearly would not have cared.

Compensation

In April 2014, five years later, the Corrections Department “apologised unreservedly” and made a confidential payment to Ms Kingi’s seven children after the family initiated court proceedings. See: Apology, payout over prisoner’s death. Her children chose to sue Corrections’ chief executive Ray Smith after meetings between the parties failed to resolve matters,