British Columbia will transfer responsibility for inmate care from its Public Safety portfolio to its Health Ministry, an important change for an disproportionately unwell segment of the population that comes after years of complaints about the separate – and some say unequal – medical system in prisons.
As of Oct. 1, B.C. will become just the third province – after Alberta and Nova Scotia – to place prison medical needs under its health portfolio, according to a memo obtained by The Globe and Mail.
"This is a very positive change for BC Corrections and will enhance our ability to provide quality health care, mental health and substance use supports for inmates," states the memo, signed by corrections director Stephanie Macpherson. "[This] will result in better outcomes for inmates through improved information sharing, increased integration with providers in the community, and enhanced continuity of care for inmates on their released from custody."
The internal announcement comes just days after the College of Family Physicians of Canada released a position statement calling on Ottawa, the provinces and territories to make the switch. Prison health advocates hope it augurs a trend across the country, where public safety and justice ministries continue to operate most prison health systems.
In 2003, the World Health Organization passed a declaration urging nations to deliver inmate health care through their respective ministries of health. Since then, countless prisoner rights advocates have called for an end to these secondary health system for inmates, citing Norway, Britain and France as forerunners.
Jurisdictions that administer inmate care through health ministries have reported lower recidivism, improved file-sharing, greater participation in studies, more robust statistical monitoring and better treatment of TB, HIV, Hepatitis C and STDs.
"To suggest correctional authorities should provide health-care is like saying plumbers should do your electrical work," said Ruth Elwood Martin, a family doctor and clinical professor at the University of British Columbia who has long pushed for the change. "It's in everybody's best interest that their health and social needs are addressed so that when they leave correctional facilities, they are healthy."
Currently, B.C.'s corrections division has full responsibility for the health of inmates. The federal correctional service and most provincial jail systems operate in the same manner.
A report from the John Howard Society of Ontario last year called medical care for inmates in that province "parallel and unequal." The Globe has reported on several examples of inmates in Ontario waiting weeks and months to receive treatment for everything from broken bones to mental health.
Similar grievances exist in B.C. "We have seen lot of clients who come into custody who are cut off from medications," said Jen Metcalfe, executive director of the West Coast Prison Justice Society, a legal-aid clinic for inmates. "We've had people cut off ADHD medications and anti-anxiety prescriptions. For someone with a mental illness it's extremely destabilizing."
Federally, health care delivery is the No. 1 complaint for inmates, according to the Office of the Correctional Investigator, and many critics have called for the duty to be transferred to Health Canada.
In B.C., the Ministry of Public Safety contracts out health-care duties to a private firm, Chiron Health Services, which did not respond to a request for comment.
"Even though they are legislatively responsible for providing health care, they don't have direct control over the quality of health care that's provided," said Ms. Metcalfe. "I think the management in B.C. corrections and the medical director want the best for prisoners but they haven't been able to ensure it because it's been contracted out."
The Canadian prison population is disproportionately sick. Recent studies have found that up to 90 per cent of inmates suffer from a diagnosable mental illness and over half have an antisocial personality disorder. In Ontario, the life expectancy for women who have served time in jail is 10.6 years shorter than the general population. In B.C., an estimated 50 to 70 per cent of prisoners have hepatitis C.
"When prisoners are treated with dignity and provided adequate health care, it can only have a positive effect on the population in general," said Ms. Metcalfe.