In the forward to the Inspector of Custodial Services Report published last month, Fiona Rafter says that the provision of health services to inmates in New South Wales custodial facilities is a complex and challenging responsibility. This is due to a combination of the size of the NSW correctional system, the need to deliver these services in a secure environment and a patient group with frequently complicated medical histories and co-occurring medical conditions.
Ms Rafter says that challenges to delivering health services in custodial settings have been previously identified in public reports. ‘The 2015 Inspector of Custodial Services (ICS) report Full House noted the impact of rising prisoner numbers on the adequacy of health staffing, infrastructure and access hours.
‘Also published in 2015, the ICS report Old and Inside identified the challenge of meeting the complex healthcare needs of an increasing ageing population in an environment already strained of resources.
‘The 2018 ICS report Inspection of 24- hour court cells in NSW identified that these complexes are where the majority of inmates first enter custody and therefore it is crucial for health services to be provided at all 24-hour court cell complexes.
‘The Residential Facilities and the compulsory drug treatment correctional centre report discussed the provision of health services at these custodial centres. The Women on Remand report considered the particular health needs of women in custody.
Prisoners would rather die than be transferred to a maximum-security
Justice Action is a not-for-profit community organisation based in Sydney which focuses on abuses of authority in the criminal justice and mental health systems in Australia. Justice Action Coordinator Brett Collins says that amongst other issues, the report found that ‘Prisoners would rather die than be transferred to a maximum-security facility to access vital healthcare.
‘The Inspector of Custodial Services Report reveals the grim status of prisoner health citing 15 years of accelerated aging relative to the general population. Prisoners miss or cancel crucial appointments due to lacking transport, administrative errors, fear of other prisoners or fear of losing their stable jobs and positions in minimum security prisons.
Report paints a reality that falls drastically short of universal standard
Mr Collins says that the principle of equivalence requires that prisoners receive the same standard of health care as others. ‘The Inspector General’s 2021 Report paints a reality that falls drastically short of this universal standard. This is shown most strongly in the statistic that it takes an average waiting time in one centre of 59 days to see a GP after reporting symptoms.
‘The NSW prison health care system is under-equipped in medical staff to adequately meet the basic health care needs of prisoners. The current nurse dominated structure does not afford the requisite skill to properly meet the health needs of the prison population.
‘At Cessnock Correctional Centre only five hours of GP consultation are available each week for 675 prisoners. Partially trained nurses are offered instead of doctors to prisoners, whose health is much worse than the general population. Forty-seven per cent of prisoners have two chronic illnesses, 77 per cent have a mental health problem, and suicide attempts are ten times the frequency of others.
State governments responsible for prisoner health
Mr Collins says that State governments are responsible for prisoner health, explicitly excluding access to Medicare. ‘The Inspector criticised this arrangement and recommended it be renegotiated at least for Aboriginal prisoners to meet Closing the Gap targets.
‘For aged prisoners, release on parole to a secure aged care facility would give them appropriate health care at significant saving to the state.
‘The current callous approach of abandoning them in cells to die is a breach of Corrective Services obligation for care,’ said Mr Collins.