New analysis of prisoner healthcare highlights risks to patient safety
SAGE
Substantive changes are needed to improve patient safety in prisons, according to a new study published by the Journal of the Royal Society of Medicine (JRSM) and funded by the National Institute for Health and Care Research (NIHR). Practical changes such as timely access to healthcare services and better processes to mitigate medication-related harm should be prioritised, according to the researchers.
In the first nationwide analysis of patient safety incidents in prisons in England, researchers found that security, staffing constraints and the high turnover of prisoners are among the main barriers to the safe delivery of healthcare in prisons. They made several recommendations for how prison and healthcare leaders can work together in the interests of better coordinated and safer care.
The authors, from Cardiff University, the University of Manchester and the University of Nottingham, reviewed more than 4,000 reports from prisons across a whole year, where a patient could have, or did, come to harm.
A third of cases were related to medication – for example, patients missing doses of prescribed medication or given the wrong treatment. Staff mistakes, such as mixing up similar patient names, were the most common reasons cited, and over 20% of medication-related reports were discovered and mitigated by staff, preventing any harm to patients.
In three out of 20 reports, prisoners were delayed in accessing or unable to access healthcare, including appointments at external hospitals. Security barriers, such as when prison wings are on lockdown, and lack of staff were the biggest causes identified by the researchers, with changes to escalation policies required to prevent this and more support needed for prisons to maintain safe staffing levels.
They noted that prisoners use healthcare services three times more frequently than the general population, with poorer health outcomes. “Healthcare priorities are often overshadowed by a prison’s main objective of securing detained individuals,” the authors wrote. The risk of this is that the healthcare and criminal justice systems are out-of-sync to “adequately consider prisoner needs and responsibility of care”.
The researchers suggested that reviewing staff rotas, improving training and rethinking prison layouts could help improve access to in-house care. For external hospital appointments, they recommended revised escalation policies and plans to ensure staff escorts are put in place, and increased use of remote appointments and ‘in-reach’ clinics. Standard handover practices, policies to ensure the safe transfer of medication and prescription information, and appropriate discharge planning could help to ensure continuity of care when people transfer in or out of a prison.
The study was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (PR-R20-0318-21001). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
JOURNAL
Journal of the Royal Society of Medicine
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Patient safety in prisons: a multi-method analysis of reported incidents in England
ARTICLE PUBLICATION DATE
18-May-2023
Story by Bobby Hristova • CBC
The inmate who started a hunger strike at Hamilton's Barton Street jail this week said staffing issues and a broken system are behind deteriorating conditions at the detention centre.
"It's sickening ... lives are at stake," Jesse Bull told CBC Hamilton in a phone interview Thursday.
The strike started Wednesday morning amid what inmates say are constant lockdowns, a lack of outdoor time and the fear they may lose access to specialty TV channels.
The maximum-security jail's official name is the Hamilton-Wentworth Detention Centre.
Cedar Hopperton, a volunteer with the Barton Prisoner Solidarity Project, said Thursday the number of inmates striking is now roughly 180.
'No extra guards at all:' inmate
Bull said that in the last two months, he's only been able to access the yard and breathe fresh air once, due to a lack of staff.
"If one guard doesn't show up that day for work ... we get no yard," he said.
"There are no extra guards at all."
Andrew Morrison, a spokesperson for the Ontario Ministry of the Solicitor General, told CBC Hamilton that a maintenance project in the yard limited time outside, but a "regular yard schedule" has resumed.
However, Bull said, outdoor time was an issue even before the construction work began.
Bull said lockdowns are another issue. He said they result in three people being held together in a cell, despite there only being enough room for one.
Hopperton previously said some lockdowns have lasted three days.
While in lockdown, inmates aren't given access to hot water or jugs to urinate in either, according to Bull.
"Whenever we get locked down, it's just a staffing issue ... it's not because we're fighting or drinking," he said.
"To be three in a cell, eating where you use the bathroom, being locked down in a hot cell in the middle of summer — no."
Morrison said there were lockdowns at the jail over the past week, but he did not confirm their length of time or whether they have become more frequent.
He said lockdowns are done for multiple reasons, including security incidents, searches, infectious disease control, staff absences, maintenance and other issues.
"Where possible, partial lockdowns are always preferred to continue visitations, showers and inmate programs," the Ministry of the Solicitor General spokesperson said.
Inmate blames system, not staff
Access to mail has also been an issue, and administration is restricting who inmates can write to, according to Bull.
"It's against our rights," said Bull, adding he has been in jail for 20 months for drug-related charges.
He said he was told that administration would look into those issues.
Morrison said inmate mail is "routinely screened for security purposes" and delivered to inmates after clearing security protocols.
Bull said that during his time in jail, he's only been able to exchange his blanket to be cleaned only and gets new sheets once a month if he's lucky.
He said the workers themselves aren't at fault. In fact, Bull said, they're "great." Instead, he blames the broader system.
"There are solutions to this and everybody just doesn't give a f--k," Bull said.
"I just feel like this is one of those situations that will never get solved ... it's a broken system."
Morrison said ministry staff work hard daily to provide care to the inmates.
"The ministry has confidence in the staff and management at the Hamilton-Wentworth Detention Centre to continue to provide support and secure custody to inmates during their incarceration."
An inmate says staffing is causing issues at the jail.
Bull also said he has a message for people who say the inmates deserve to stay in deteriorating conditions — don't make snap judgments about prisoners.
"There are so many guys in here that have so much talent, who are highly intelligent, artistic, who have families and jobs and made a wrong turn somewhere," he said.
"People are forgetting humanity ... I really feel with every fibre in my being this needs to be taken care of at a higher level than just jail administration ... we're people too."
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