New corrections policy accused of putting West Australian prisoners’ health at risk

Western Australia has drastically reduced medical care for new prisoners, putting an already vulnerable group at further risk, according to WA’s peak medical body.

Until December of last year, Department of Justice process was that a new prisoner would see a doctor for a full medical assessment within 28 days of admission. This would allow the prison to identify chronic problems, manage a prisoner’s medications and identify psychological or psychiatric issues among other issues. Now, groups of prisoners will see a nurse as they arrive at a facility.

Australian Medical Association Western Australia vice president Dr Mark Duncan-Smith told Crikey the AMA (WA) has serious concerns over the Department of Justice’s policy change. 

“This was a decision made without any consultation with doctors working in our justice system,” Duncan-Smith told Crikey. “Prisoners are a high-risk group and often come from a background of poor lifestyle choices, substance abuse issues and the health conditions associated with it. “

A spokesperson for the Department of Justice denied the assertion that no doctors had been consulted.

“Revisions to the Department’s clinical policies are made via consultation with key staff, including medical staff, and are based on evidence and benchmarking against similar services,” they said.

“Policies are then submitted to the Department’s Clinical Governance Advisory Committee for review and endorsement, which has representation of medical doctors, nurses and also the Health Consumer Council.”

They said further a 2017 review of the Department’s admission assessment found there was “neither evidence nor clinical need to support the requirement that all offenders be seen by a medical doctor within 28 days of entering a custodial facility”. 

However Duncan-Smith said without a full medical assessment from a qualified doctor, prisoners run the risk of long-term health implications that nurses are not appropriately trained or qualified to pick up on.

“There is also no alternative strategy in place to manage chronic health issues that are missed on the arrival of a new prisoner,” Duncan-Smith said.

“Frankly, this appears to be a short-term cost cutting measure undertaken without proper consultation that will result in increased costs and poor health outcomes for an at risk group.”

Prisoners in Australia are disproportionately likely to have chronic health issues. The Australian Institute of Health and Welfare found in 2014 that:

• One in three prison entrants reported having one or more chronic conditions — asthma was the most common, followed by arthritis and cardiovascular disease.
• 34% of female prison entrants and 21% of male entrants tested positive to hepatitis C, compared with an estimated national prevalence of 1.4% .
• A large proportion of entrants reported a history of mental health-related issues; almost two in five (38%) reported having ever been told they had a mental health disorder.
• On reception to prison, about one-quarter of prison entrants were referred to mental health services for observation and assessment, and 20% of all prisoners took medications for mental health-related conditions while in custody.

Prisoners are also likely to engage in risky health behavior like smoking, heavy alcohol consumption and illicit drug use, and the majority of prisoners about to be released reported that their physical health had gotten “a little” or “a lot” better since being in prison. 

The departmental spokesperson said the clinical nurse who assesses new prisoners is supported by an on-call doctor if required, that prisons are regularly attended by medial officers such as GPs and dentists, and have established protocols with local health campuses to use their services if required.

“Referrals are also made to WA Health Services for offenders requiring specialist and/or tertiary care,” they said. “Care plans are developed for all offenders with chronic conditions, such as diabetes, or with a mental illness.”