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The Ombudsman PO Box 10152 Wellington 6143 Copy to Anthony Hill Health and Disability Commissioner Dear Ombudsman

9 October, 2013

I am writing in response to a letter received from Mr Hill, Health and Disability Commissioner, dated 27 September, 2013 regarding a letter I wrote to the HDC about the HDC report titled "Team development workshops for prisons nursing services delivered by Dr Elizabeth Finn and Mr David Webber". That report appears to endorse section 6.1.1 of the Corrections Department Medicines Policy which actively discourages prison doctors from prescribing certain medications to prisoners. I asked the HDC five questions, one of which was - does the Commission still endorse or condone the ‘discouraged medication policy’? Mr Hill has replied that the Finn/Webber document "is not an endorsement of any practice or policy of the prison health service. It is a report to the prison health service that summarises former education manager Elizabeth Finn's observations following her workshops and training sessions… It is not HDC's practice to endorse the policies or procedures of healthcare providers or disability service providers." Mr Hill’s reply is contradictory and confusing. 1) His statement that the Commission does not condone the discouraged medication policy is entirely at odds with statements made by Dr Webber in her report. She wrote: “It appears that some doctors are not sufficiently aware of the context of the prison environment and the particular challenges it presents. For example, some medications are inappropriate in this environment because of their potential for use as ‘currency’. Lack of national consistency with respect to provision of medications to patients who are prisoners may lead to stand-over tactics and abuse directed towards doctors in the first instance, and also towards nurses. A robust induction programme for doctors would be helpful.” On page 5, the report even reprimands doctors in hospital Emergency Departments – apparently for not doing what they are told by prison nurses. It says: “EDs may not cooperate with advice from nurses that certain medications are not allowable in prisons, and still prescribe these (codeine, morphine).” Mr Hill says this is not an endorsement but is "a report to the prison health service that summarises… Elizabeth Finn's observations following her workshop and training sessions." Mr Hill is playing with words. Dr Finn is or was an employee of the HDC. After conducting workshops at 13 prison health centres, she sent her report to those prison health centres (and to the ombudsman) clearly stating "some medications are inappropriate in this environment because of their potential for use as currency". It would be totally reasonable for health service managers at Corrections to take this as an endorsement by the HDC of the discouraged medication policy. It is therefore quite specious of Mr Hill to claim that the HDC has not endorsed it.

If the HDC seriously does not wish to endorse this policy then Mr Hill needs to write a letter to Corrections management stating that Dr Finn and Mr Webber drew some erroneous conclusions in their report. And he needs to make it very clear that the HDC does not endorse this policy. Until he does so, Corrections will continue to live under the perception created and perpetuated by Dr Finn that the HDC does support the policy. 2) Another question I asked of the HDC was – “Did whoever investigated each of these 36 complaints (in 2012) make any enquiries (either of the prisoner or the prison health service) to ascertain whether or not the prisoner who made the complaint had been denied a ‘discouraged medication’. “ Mr Hill replied: "unless medication administration was an issue identified in the complaint or arose during the complaint assessment process, HDC would not have actively sought to ascertain whether the prisoner concerned had been denied a discouraged medication." Mr Hill appears to be saying that the answer to the question is no - the HDC did not make enquiries to ascertain whether or not prisoners who made complaints had been denied a discouraged medication. If prisoners are told by a prison nurse or doctor they are not allowed morphine (for example) because of prison policy and are given Panadol instead, even when in severe pain, on what grounds would the prisoner make a complaint? If health staff are simply following policy, what is there to complain about. Prisoners, especially those with health problems, are in a vulnerable position. Their ability to stand up and fight for their rights is extremely limited. They would be unlikely to know that the Department's discouraged medication policy is potentially a breach of Section 75 of the Corrections Act, Section 151 of the Crimes Act, the Crimes of Torture Act, 1989, and the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. It therefore seems unlikely that choice of medication would be identified as an issue during the complaint assessment process unless the HDC investigator deliberately asked questions about it. This means it is incumbent on HDC investigators to ask these questions rather than blithely assume that prisoners are aware of their rights and that these matters would automatically arise during the complaint process. In my opinion, the fact that HDC investigators do not ask these questions on a routine basis is further evidence that the HDC - perhaps by omission – ends up endorsing the Departments policy. If, as Mr Hill claims, the HDC does not endorse this discouraged medication policy, then HDC needs to advise the Department of that - and its investigators need to start asking questions about medication issues when prisoners complain about their medical treatment. I request that you take these matters up with Mr Hill. Yours sincerely

Roger Brooking P.O.Box 29075, Ngaio, Wellington