Despite small improvements our prison service remains vulnerable to appalling incidents of mistreatment and cruelty. Dick Skellington reports.
A common thread through these posts reveals a lack of care for individual welfare that at times is alarming. Prisons have difficulty balancing the priority of security with humane and dignified treatment. A friend of mine, aged 76, who has served 29 years in prison, recently had a cataract operation at Kingston Prison in Portsmouth. He wrote to tell me that throughout the procedure he was handcuffed to the bed. My friend, it is a long story, is incarcerated on recall for an offence which he did not commit, has a impeccable record while inside and is not considered a danger to anybody. So you may wonder at my capacity to be surprised by further revelations.
But when I read the report by the Prison Ombudsman, Nigel Newcomen, into risk assessments and the use of restraints for seriously ill and dying prisoners, I was taken aback. Yes the report, which looks at provision in England and Wales since 2007, demonstrates there has been marginal improvements in care. Prisons like Kingston – one of the few prisons in England and Wales which has a wing for elderly prisoners -– have introduced a planned approach to treating sick and terminally ill prisoners, one more tailored to their needs, though do not tell my friend. Nevertheless, despite some sympathetic regimes, a disturbing trail of shocking incidents have been uncovered by the ombudsman.
Over 50 dying prisoners were wrongly chained or inappropriately handcuffed during their final days in hospital. A terminally ill cancer patient died while handcuffed to a prison officer. His condition was only confirmed as terminal two days before he died, but the restraints were not removed even when he was short of breath and could not move far from his hospital bed. Another prisoner in a medically induced coma remained chained throughout.
The ombudsman found restraints such as escort chains and handcuffs were used on the majority of dying prisoners who were admitted to a hospital or hospice in the last six months of their lives since 2007. In 23 of the 51 investigations restraints had been inappropriately used as recently as 2012, often on frail, infirm and weak prisoners. Longer sentences and more offenders being sentenced later in life mean that prisoners aged 60 and over are now the fastest growing age group in jails across England and Wales, and that it is more likely that prisoners will die in the care of the system.
"An older and ailing population brings new challenges and the past decade has seen deaths from natural causes outstrip self-inflicted deaths as the principal cause of death in prison custody. In 2011-12, there were 142 deaths in custody from natural causes, an increase of 20 over the previous year," said the ombudsman.
The ombudsman found that prisoners who were already ill attending hospital remained chained and cuffed, even if their condition became terminal. Furthermore, concerns raised by escort or medical staff were not appropriately considered, and restraints were routinely applied according to a prisoner's security category or offence rather than the risk presented and, in some cases, restraints remained in place even as release on compassionate grounds was being sought.
The report concluded that the right balance between decency and security is still not being achieved. Too often an overly risk-averse approach is taken when frail, immobile or even unconscious prisoners remain restrained. The ombudsman recommended that whenever a risk assessment is completed, the prisoner's health and how this impacts on risk should be assessed. Too often the restraints used if the prisoner was fit and well are applied to cases of serious ill-health. It is important that changes in the prisoner’s condition prompt an immediate review of their restraints to prevent them remaining in place longer than necessary.
This report raises serious questions about the humanity within our prison establishment, an establishment further shaken by a report in February following the release of Daniel Roque Hall, a disabled man suffering from a terminal condition, Friedreich's ataxia, which causes loss of physical co-ordination. Daniel was given a three-year sentence after admitting trying to smuggle cocaine worth more than £300,000 in his wheelchair from Peru through Heathrow.
According to his family and lawyers, within hours of admittance to prison, Daniel suffered a spasm and fell from an examination couch, sustaining a head wound. He was taken in handcuffs to a care home for elderly people. Staff there were not given full details of his medical requirements, which included Warfarin, prescribed to thin his blood. He was moved to Wormwood Scrubs, where he suffered further spasms and was denied his full medication. The two constant carers he needs, in case of spasms, were not supplied, nor were the stretching exercises. Hall's condition deteriorated rapidly and in the early hours of 23 August he was rushed to University College Hospital, London, and placed on a life support machine. A consultant at the hospital said Hall's heart had been "stunned" by his treatment at the prison. His GP says his life will be threatened if he is sent back to prison. No longer on a life support machine, Hall remains in hospital while his lawyers seek a judicial review of his treatment. (See article here).
In February the Law Lords at the Royal Court of Justice reduced his original prison sentence to 18 months and Daniel was released. The Court ruled that his serious disabilities which leave him unable to move his limbs, feed himself or use a pen or telephone, meant he should not be returned to prison. Daniel could not attend the hearing, not because of illness, but more worryingly because the Royal Court of Justice does not have adequate disabled access.
Daniel's solicitor regretted that the Court did not conclude that the treatment Daniel received violated his human rights. His team concluded: 'Daniel's case is exceptional but he is certainly not the only prisoner in England and Wales who has serious disabilities or health problems. All are entitled to expect the equivalent level of care they would have access to if they were in the community, but there are serious concerns about the ability of the prison service to care for them.' Following Daniel's release a spokesman for the prison service commented: 'The Prison Service holds in custody those sentenced by the Courts and it is committed to treating all prisoners humanely and decently.'
Currently the mission statement for the HM Prison Service highlights three objectives. First is to hold prisoners securely. Second to reduce the risk of reoffending. And third to 'provide safe and well ordered establishments in which prisoners are treated humanely, decently, and lawfully'. Perhaps there are tensions in that third objective between delivering 'well-ordered' establishments and decent treatment. Maybe it is time for the service to give decent treatment its own objective, distinct from the desired order of the prison itself.
For, despite the claim from the prison service following Daniel's release, the findings of the prison ombudsman's investigation and the Daniel Roque Hall case demonstrate that the Home Office really does need to do some very clear thinking about establishing humane treatment for sick and disabled prisoners in its care. This will mean the prison service must re-evaluate its commitment to humane and decent treatment, and look again at its mission statement, to ensure it is delivered. The evidence suggests that pious statements are not enough and fool no one.
Dick Skellington 14 May 2013
The views expressed in this post, as in all posts on Society Matters, are the views of the author, not The Open University.
Cartoon by Catherine Pain