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Super jail risks inmates' health: MD

E.R. doctor calls care inappropriate
U.S.-run private facility denies charges

Roberta Avery
Special to the Toronto Star
Feb. 28, 2003

PENETANGUISHENE—The health of ailing inmates at Canada's first and only privately run jail is often at risk due to inappropriate medical care, says the head of the emergency department at a nearby hospital.

Dr. Martin McNamara, of the Huronia District Hospital in Midland, whose department sees about two inmates from the Central North Correctional Centre daily, says some arrive writhing in agony because they haven't received proper pain medication, or with physical conditions that have worsened through neglect.

Delays in medical care in some cases have been so serious that "yes, the health of the inmate has been put at risk," said McNamara, who added that he wasn't blaming the doctors or nurses employed there.

McNamara's voice is the latest in a growing chorus of judges, lawyers and activists critical of the for-profit institution guaranteeing, they say, its bottom-line results by minimizing inmate care.

The institution has denied the accusations.

McNamara said his department has treated inmates with wounds that have become seriously infected due to neglect and fractured bones that haven't been X-rayed and set.

As well, he said more serious illnesses have been ignored because it was thought the inmate "was faking it or making it up," he said.

One of McNamara's own patients, who broke his jaw before he was incarcerated at the jail more than three weeks ago, is still waiting to see a dentist.

"As of two days ago, he was still wandering around in pain with a broken jaw," he said.

Doug Thomson, who has been running the jail for U.S.-based Management Training Company (MTC) since it opened just over one year ago, disputes McNamara's claims.

"There's no validity to them," said Thomson in an interview.

The MTC, based in Centreville, Utah, charges the province $75 per inmate per day, as part of a five-year $141 million contract, compared to between $140 and $200 that it costs the government for each inmate per day in a public institution.

The jail employs two doctors. Its medical care, which has been contracted out to Arizona-based First Correctional Medical, has been found adequate during two recent audits by the province, said Thomson.

"We meet the standards laid out in our contract," he said.

That's not how Dr. Paul Humphries, the senior medical consultant to the Ministry of Public Safety and Security, saw it when he visited the jail last December.

Humphries, in an interview yesterday, said that when he visited the jail, he pulled medical charts of a number of inmates at random and found a number of instances where the "institution was not compliant with ministry policies."

"There were a few things we didn't like ... it's not the way our other (public) institutions are run," he said.

While most of the non-compliance was of a minor nature, "there were several instances that could have become serious," said Humphries, who refused to be more specific.

The jail accepted his recommendations and promised to change its practices, he said.

"We want to go back every two months and pull charts to see that it's (compliance) happening," Humphries said. "We're taking every step possible to ensure compliance with ministry policies."

Humphries said he is aware of McNamara's concerns and hopes to meet with him and assistant deputy minister Garry Commesford in the next few days.

McNamara has high praise for the doctors and nurse practitioners who struggle to run the jail's recently opened infirmary.

"They're doing a really good job, but one doctor for (1,100 inmates at a time) is woefully inadequate," said McNamara.

Thomson said two doctors are on staff at the jail — alternating with one on duty at the jail five days a week, while the other is on call 24 hours a day, seven days a week.

Five nurses work the day shift, four the evening shift and two the night shift.

Humphries is trying to determine if that ratio at the facility is comparable to public-run institutions: "That's one of the things we are looking at," he said.

Requests for interviews with the doctors at the facility, and with First Correctional Medical CEO Tammy Kastre in Tucson, Ariz., were referred back to Thomson, who said he was the only spokesperson.

Last week, Justice Elizabeth Earle-Renton spoke out at the trial of Ryan Skillen, 24, a suicidal man who blew off part of his hand while placing a homemade bomb on a path used by Barrie high school students.

"The court is not blind to what is happening and what is not happening at the Central North Correctional Centre," said Earle-Renton.

She said judges, crown attorneys and defence lawyers have been expressing in court, and "certainly in private for some time," that based on the "information we receive, the situation at the correctional centre is not particularly good and not helpful to inmates."

Noting Skillen's fragile mental state, Earle-Renton said that she would recommend he serve his 18-month sentence in the Ontario Correctional Institute in Guelph, where mental health assessments are carried out.

"It's of great concern that the recommendations from our courts are not being obeyed," she said.

Skillen's lawyer Mitch Eisen told Earle-Renton that a jail run for profit has little incentive to transfer inmates to another facility.

"They want to collect the head tax," said Eisen.

Defence lawyer Ben Fedchuk told a Barrie court in December that the jail's lack of concern for the medical well being of inmates was "scandalous."

Requests for medical attention for one of his clients, who was in the jail awaiting trial, were ignored even after a judge recommended the man get medical attention, said Fedchuk in an interview yesterday.

"The whole medical situation there is a disaster waiting to happen," he said.

Although Thomson has heard "occasional complaints" from inmates' parents or lawyers, he's yet to hear anything from any judge, he said.

Recommendations made by judges in warrants of committal are considered by the jail on an individual basis and are followed if they are found to be appropriate for the inmate's program, said Thomson, who added he didn't have statistics on how many judges' recommendations are not followed.

"The courts have not contacted us," said Thomson, adding he has asked for a meeting with local judges and crown attorneys to discuss any concerns.

Complaints about the jail's medical practices are the latest in list of issues at Ontario's experimental facility.

Last month, the jail ended the practice of having the race of inmates on their photo ID tags following complaints that it was a violation of human rights.

Last September, more than 100 inmates rioted and tried to escape using a battering ram.

Since then, a third of the inmate population has remained in lockdown and are in their cells 19 hours a day unless they are attending school or special training.

A day before the riot, 187 guards voted to unionize.

McNamara said it took sending a letter to the local medical officer of health before a hepatitis B vaccination program was initiated for the jail guards.

"They were coming in with bites and scratches so they were at serious risk," he said.

Public-run institutions vaccinate each of their staff against Hepatitis B for about $100 each.

"But in a private-run enterprise, profit comes at the expense of the workers and that's abhorrent," said McNamara.

In discussions with the Ministry of Public Safety and Security and jail management before the facility opened, the local hospital was told to expect to see about one inmate a week in the emergency department.

"Instead of that we're seeing on average two a day. I saw three myself this morning (Wednesday)," said McNamara.

Such an influx of patients is putting a huge burden on a local health service already designated as under-serviced and a hospital already $3 million over budget, said McNamara.

As the hospital doesn't have a secure area, patients often find themselves lying next to an inmate in shackles in the emergency room, he said.

Earle-Renton is not the only judge to express concern in open court about treatment of some prisoners at the facility.

"I'm hearing too much of this," said Justice Gary Palmer in court on Dec. 23, 2002, after learning that a man brought before him on drunk driving charges was not getting his prescription medication at the jail.

MPP David Levac (Brant), the Liberal prisons critic who visited the jail on Tuesday, said he's been hearing a lot about it.

"A lot of the complaints centre around inmates not getting their medication," said Levac.

He described the atmosphere at the jail as "volatile."

"They've had one riot about conditions at the jail and I can tell you that conditions are ripe for another," said Levac.