October 20, 2014

Features | March 24, 2014
An abatement of care
The struggle for adequate prison healthcare
Written by | Visual by Alice Shen | The McGill Daily

“It’s hard not to fall in love with people in prison,” said Mo Korchinski, a former prisoner in provincial correctional centres in British Columbia (BC). Mo spent almost six years in prison serving several different sentences. “You hear their stories, and you hear them crying, and they really want help… It’s really humbling.”

She now works with formerly incarcerated women at the University of British Columbia’s (UBC) Collaborating Centre for Prison Health and Education, helping the women take care of their healthcare needs within the first three days of release.

The first 72 hours are a critical step in protecting many prisoners from relapse. Because so many are imprisoned due to addiction-related issues, those three days are also crucial in terms of ensuring quality, continuous healthcare.

If the prison system were to meet a rehabilitative ideal, the transition from prison to mainstream society would be seamless. It would be taken care of entirely by the state, with the goal of preventing recidivism – or relapse in criminal behaviour that often ends in re-imprisonment. Even though crime rates have been on the decline since the early 1990s, the Harper government implemented a “tough on crime” policy that involved both cuts to the prison system and a skyrocketing prison population. Far from prioritizing the needs of prisoners, such an attitude sidelines their most basic well-being by failing to provide adequate healthcare. Quite frankly, most governments in the world don’t, because for most people, prisoners are criminals, and criminals are considered the scourge of society.

“When we see a growth in the population, not only do we see an increase in the number of men and women going to prison, we’re also seeing an increase in the amount of time that they stay [there],” said Howard Sapers, the correctional investigator of Canada, whose office oversees the corrections system and is charged with evaluating the system through a human rights lens.

“This is very important for Corrections because the health profile of federally-sentenced offenders is a far different health profile than Canadians as a whole. Offenders tend to [...] have more illness [...] – they tend to have more complex health demands.”

Sapers’ office fields over 20,000 corrections-related complaints per year. And although prisoners are an incredibly vulnerable and high-needs population in terms of healthcare, the need hasn’t translated. Healthcare complaints, particularly complaints regarding access to healthcare in prison, make up the biggest category of complaints that the correctional investigator’s office receives.

 

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Peter Collins has been imprisoned for the past 30 years in Ontario. During his time in prison, he has worked as a peer health counsellor and has been an outspoken voice for prisoner justice. In 2008, he won a Human Rights award from the Canadian HIV/AIDS Legal Network and Human Rights Watch due to his work in prisoner health education. Peter spoke plainly about the challenges that prisoners face in acquiring decent healthcare.

“It’s always been a challenge to be seen by healthcare at all the prisons that I’ve been in, and it’s getting worse now that there’s less money and more people being squeezed into these places,” he says. “But before that, aside from the recognition that there’s obviously [...] some good nurses and doctors working in these places, the culture of prison lends itself to being dismissive and not really attentive, or being non-responsive to people’s needs.”

“[Healthcare] is not a priority, and it’s because they don’t care about us,” he added. And for that indifference, Peter blames a society that stigmatizes anyone who passes through the prison system.

“You can see that in society’s general stance toward prisoners. We’ve educated ourselves as a society to consider anybody who’s been convicted of a crime to be some kind of pariah not deserving of many, many things – and it’s just so ingrained in our social structure that often taking away certain things is viewed as the right thing to do by the majority of people who don’t think about it. Because they’ve been desensitized to the fact that there’s people in these places, and that these people are their brothers, fathers, mothers, sisters, children.”

Not only are prisoners’ needs are just as urgent as those who are not imprisoned, the health of prisoners is intrinsically linked with public health; the overwhelming majority of prisoners are eventually released and then need to be reintegrated into society. Their health issues are a matter of public health, and the debate over whether or not we should “care” about prisoners should be recognized as utterly irrelevant.

 

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Anne* spent almost 20 years in and out of the prison system, and was most recently in a mixed federal-provincial level women’s prison in BC. She’s been out for five years now, and works as a peer health counsellor to help women transition their healthcare needs from prison to reintegration.

Her story begins with problems that she attributes to a challenging childhood, leading her to make decisions that took her into prison for nearly two decades of her life.

“I ended up getting involved with drugs at a very young age – like 12 or 13 – and I left home at like 15,” she said.

“By the time I hit 24, I had been in prison half a dozen times, but once I hit 24, I began chemical addictions. I was into heroin and a cocaine addict, and I used to do property crimes – shoplifting, sell drugs, fraud – to support my addiction. So I was in and out of corrections all the time.”

Anne’s addictions also led her to contract Hepatitis C, which contributed to her poor health. Although she was never in prison for a particularly long time, she got trapped in the “revolving door” of recidivism and corrections – an issue closely linked to the problems with continuity of healthcare once outside prison walls.

“I started out with small sentences, like 30 days, 60 days, and my sentences didn’t really get that big, but it was consistent. Sometimes, the longest I could stay out was two months – three months was like a record for me.”

But for Anne, prison provided her with more resources to rehabilitate herself than those available to her on the outside. She associates this with a sense of stability that she found everyday life lacked. And many former prisoners said that maintaining their health behind bars provided them a sense of agency over their own bodies – a sense of ownership and personal control that’s typically lost in the highly-regulated prison environment.

“I never saw any healthcare providers when I was on the street. I would go to prison and I would get tests done, and start looking after my health, start getting healthy, looking good, feeling good, and then, boom, I’d get kicked out of the door with absolutely nothing but the clothes on my back and nowhere to go.”

“A lot of people say, ‘Oh, prison’s so bad,’ but I don’t say that because prison saved my life,” she said. “It saved my life numerous times. […] I wouldn’t care if I went to prison. I would be using as hard as I could, as much as I could, and I didn’t care how much crime I did, because I really didn’t care if I got caught.”

But while some people, like Anne, find that their health benefits from time in prison, not everyone has the same experience. Prisoners face rates of HIV and Hepatitis C 10 and 30 times higher (respectively) than that of the general Canadian population, often due to sharing needles – both behind bars and in the outside world.

 

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In prison, healthcare works differently. Prisoners must file requests to see a doctor. Because doctors are typically busy, they often end up seeing nurses, and sometimes, serious issues fall through the cracks. Prisoners have little power to see a doctor of their own initiative, because they first have to be approved to see one.

Tammy spent about ten years in the provincial and federal systems, serving multiple sentences. While in prison, her health and well-being came at the expense of security concerns.

During her sentence, Tammy came down with what felt like a cold. In her mind, though, going to see a doctor was not worth the trouble.

“After you’ve dealt with healthcare a number of times in prison, you never get the same doctor twice, there’s all kinds of things, like you kind of have to almost be half-dying before you even bother, because it’s not worth it, right?”

Soon – after about three days – she found she wasn’t getting any better, and she put in a request to see a doctor. Because her symptoms appeared to align with those of a common cold or flu, she never saw a doctor.

“At that point, I was so deathly ill that I couldn’t even get out of bed. Like it was terrible. And so then, the correctional officers that work on the living units were like, ‘Oh my god, what is wrong with you?’ Like eight days later.” Tammy was taken to the emergency room after about two days – though the process of getting to the hospital was much slower, due to security concerns.

“When I got to the hospital, because you’re handcuffed and shackled, which means you’re chained around your ankles, and all of those things are attached to something called a belly chain, which goes around your waist, so you’re attached to all that, so of course when I got to the hospital the treatment was –” she paused, taking a deep breath, “Holy smokes, jeez, even thinking about this stuff makes me emotional because I haven’t thought about it in so long.”

“Of course I was treated as a sub-par human being, because people are scared,” she continued. “They’re scared of what they don’t know, right? And then it took ten hours to get into the emergency [room], and when I did I had to have emergency surgery right then and there – I almost died.”

“I had the surgery all handcuffed and shackled to the table, which was crazy, and the guard even wanted to come in with me, but the doctor was kind enough to let me have a modicum of respect and privacy and told the guard no, to wait outside the door, that I would be fine. […] I didn’t have to stay overnight – they sent me back to prison right away with instructions on how to stay well. And they gave me a prescription for painkillers, which I was not allowed to have in prison because they were a narcotic-based painkiller, so they didn’t let me have them.”

Instead, Tammy says, she took over-the-counter painkillers after her surgery – and never received any follow-up treatment. While the use of narcotics in prisons is limited, again, because of security concerns, spending on prescription medications within the healthcare system has gone up overall, according to Sapers.

And according to Tammy, the most proactive healthcare that she and many other prisoners received while incarcerated was in the form of prescriptions for psychotropic medication.

“If you talk about the fact that you feel depressed or down, they immediately want to put you on some type of medication so that you’re not an issue for security within the prison,” she said. “[But] I don’t know all the inner-workings of the correctional system, I just know what happened to me.”

The increase in spending on prescription medications appears to largely be related to mental health concerns, as several regions of the country – particularly the Atlantic region – have seen a spike in the use of psychotropic medications.

Tammy, who now works as a peer health counsellor with women upon release, hears of the same patterns continuing.

“When [women] come out, I hear the same stuff, like, ‘Oh my god, it would just be easier if I was – you know, you have to be half-dead before I want to go to healthcare.’ […] You have to go through this whole line of security, right? First, you have to get through the guards, and then you have to talk to the nurses, and then sometimes the nurses end up thinking they’re doctors, and they’re diagnosing you, when all you really want to do is see a doctor and let them tell you what’s wrong. And then when that’s done, unless you follow up yourself – unless you have the mental stamina or the ability to advocate for yourself, it is really hard, you get lost in the system.”

 

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In 2008, Christine Hemingway filed a lawsuit against BC Corrections, Surrey Pretrial Services Centre, and Alouette Correctional Centre for Women. She claimed that there had been a violation of the Charter of Rights and Freedoms in the poor healthcare she received while in provincial prison.

After Christine’s initial illness, and only grew sicker as she was continuously denied care. Christine’s case, in many ways, demonstrates the tension between security and healthcare found behind prison walls – a tension that is only made worse by the fact that in BC, prison healthcare is private.

Christine’s troubles began with a basic bladder infection. While she requested an appointment with a doctor – a standard practice for prisoners seeking care – she was denied. That bladder infection soon turned into a kidney infection, later to morph into kidney stones. Christine’s health soon spiraled downward, resulting in blood infections, blood clots, and multiple visits to the emergency room.

“Every time I was ill, I kept requesting to see the doctors and saying, ‘There’s still something wrong with me,’” she says.

Christine’s medical problems eventually snowballed into an emergency blood transfusion – though she claims that, instead of being allowed to stay in the hospital for supervision after the transfusion, she was shuttled straight back to the prison.

“I survived all these illnesses which were unnecessary to start with,” she says. “So I decided that I’m going to take them to court.”

After spending approximately $5,000 of her own money, Christine settled with BC Corrections in February – making the system acknowledge its wrongdoing in handling her healthcare.

“It was never really about money,” she says, “It was about getting them to admit that they had not given the proper treatment inside the jail.”

BC is unique in that its provincial system outsources prison healthcare to a private contractor, creating a dynamic that Christine sees as pushing profit over well-being or safety – greater, even, than the already-existing tension between security and healthcare.

Advocates have been pushing for BC’s provincial prison healthcare system to be transferred and placed under the Ministry of Health, arguing that it would reduce recidivism rates, result in more consistent treatment of tuberculosis, HIV/AIDS, Hepatitis C, and STDs, and help ensure continuity of care upon release.

But for Christine, the fact that her healthcare was provided by a private contractor meant something far more insidious.

“It’s all about the bottom dollar,” she says. “It’s all about saving money. So they’re going to cut corners wherever they can.”

 

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The complex healthcare needs of prisoners seem daunting. According to Sapers, 70 per cent of federally sentenced women have histories of sexual abuse, and 86 per cent have been physically abused at some point in their life. 80 per cent of federal prisoners face addiction or substance abuse issues – and two-thirds of federal prisoners were intoxicated when they committed their index (the most serious of the crimes that landed them in prison).

And according to several former prisoners, drug use is rampant even behind bars, contributing to the spread of infectious disease within prison walls – an issue that only grows worse with increasing crowding in prisons.

But the system is still working to catch up with their needs – or arguably, isn’t working all too hard to meet them in the first place. And the ongoing friction between security and healthcare has only grown worse with crowding, according to Sapers.

“Crowding creates a scarcity of resources – and that’s all kinds of resources, including human resources. When you’re operating your prisons at capacity or over capacity, you’re really faced with some real operational issues. […] Everything is okay, as long as nothing out of the ordinary happens. But as soon as an extraordinary event happens – as soon as there is a medical emergency, as soon as there’s things like a power outage [...] it interrupts the prison routine. It just has a cascading effect.”

Bridging the gap between release and community remains a crucial issue – but even more pressing is the need for better harm-reduction measures to ensure quality care before putting people behind bars.

“I would never say that prisons shouldn’t be health providers because people in custody will always have health needs,” says Sapers. “But on the other hand, it seems to me to be counterproductive and extraordinarily financially inefficient to meet healthcare needs for people by putting them in jail. If you’re dealing with somebody who is profoundly ill, we should be dealing with them primarily as patients. And if they also happen to be offenders, we can deal with the security needs. [...] I believe that we’ll get a much more therapeutic outcome and a more financially responsible outcome if we deal with their healthcare needs primarily.”

Peter echoed the sentiment, noting the general societal indifference to prisoners.

“If you’re truly interested in dealing with social problems, you would deal with poverty, and you would deal with disenfranchisement, you would deal with the systemic racism – all the negative things in our society that impact this. The inequality, the disproportionate – all that stuff. If you’re interested in solving crime. But [Harper]’s not. He’s interested in having a scapegoat.”

*Name has been changed

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