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Canada: More on activist's fight against MTC.
BARRIE — After the operation on the remnant of his hand by plastic surgeons in a London, Ont., hospital, Ryan Skillen was transported to the medical unit at Penetanguishene's superjail. With all that could be done to rescue what was left his hand, blasted and burned by a bomb he made, Skillen arrived with a medication list from his surgeon and doctor's orders to keep the arm elevated.
He says his time at Central North Correctional Centre (CNCC) was hell on earth, and it wasn't until he was transferred to Ontario Correctional Institute (OCI) in Brampton that he began receiving the required treatment.
During a two-and-a-half-hour interview at their north-end Barrie home, Skillen and his mother, Sharon Storring-Skillen, recounted his time at CNCC.
He was incarcerated at the Penetang superjail from Sept. 18, 2002 until May 1, 2003. Skillen's awakening came when he was transferred to OCI, a medium-maximum security facility where the focus is on rehabilitation and treatment as opposed to being “a warehouse for guys,” he says.
“It gave me perspective, and made me realize CNCC needs to focus on health care,” he said, clearly frustrated by what he sees as maintaining the bottom line over prisoners' needs and rights.
At CNCC the norm was shackles and handcuffs and being left behind thick glass, Skillen said, while at OCI “you look somewhat normal... and feel like a person whereas at CNCC they treat you like animals.”
Skillen claims CNCC medical staff cut back on the prescribed amount of medication he was given by his doctors, which he says was for monetary reasons.
“I couldn't understand their reluctance to give me my medication based on cost,” said Skillen, who added that about four days into his term the prison physician told him the drugs he was prescribed were too expensive, and that they were often abused.
Skillen said the pain from the lack of proper medication was unbearable, and other alternative drugs made him hallucinate. He said he understands drugs can be a prized commodity in jail, and could be traded for other legitimate products, but that was no reason for him to have to endure the pain.
To compound the problem, Skillen says his bandages — which contained “a mangled mess” — were not changed as regularly as required. About six days into his incarceration, a nurse removed bandages on his hand where he had 78 stitches, revealing a swollen and infected wound.
CNCC administrator Doug Thomson said inmates have the same access to health care as inmates in public facilities; prisoners may even receive better health care than the public, he added. Delivery of health-care services at CNCC often mirrors society, he said.
“It's very difficult to get a doctor (in society). Are there delays in seeing specialists? There are delays in the community for all of us,” Thomson said.
“They get the same level of service as you and I do,” said Thomson during a three-hour sit-down interview inside the prison. Due to confidentiality regulations, Thomson does not have access to prisoner medical records and could not discuss case specifics regarding Skillen.
The prison has a health-care unit, which prison spokesperson Peter Mount stresses isn't a hospital, but still more than most jails.
There are limited facilities inside the jail, but any serious injuries that require specific technology or expertise — such as X-ray or setting broken bones — are sent to Huronia District Hospital in Midland.
“Not every facility in the province has a 24-hour medical unit,” said Mount, and CNCC is one of only two facilities offering around-the-clock nursing care.
The medical unit includes 16 beds, and a registered nurse is on site throughout the day.
“I'm very pleased with what I've seen for medical services here,” said Thomson. “It's a very busy unit. We get most of the referrals across the province for some of the hard-to-manage offenders with health care.”
Of prime importance to Thomson is implementing a provincewide continuity-of-care program. He said there have been occasions where an inmate has arrived at CNCC with, for example, a broken nose that went unnoticed at their former facility.
Thomson has 25 years experience in the public sector, and has viewed corrections from both sides of the private-public coin.
“Coming from government I think everything needs to be reviewed,” said Thomson, who commended the current Liberal government for investigating alternatives. “It's taxpayers' dollars that they are spending so there has to be some performance measures to that.”
But there are also challenges to running such as big prison, which can house up to 1,184 inmates. The size and design of the building and its operation forced administration to go back and revise some logistical items.
“We've had to go back and review a few things,” said Thomson, including laundry, food and medical service. “This facility's huge... (but) we've made an effort from Day 1 to always have health-care professionals.”
“We've never had substandard professionals in our facility,” added Mount.
“Our doctors are certified in Ontario, and our nurses are registered nurses as they would be elsewhere,” said Thomson.
“Because you're always receiving offenders, there's always going to be issues,” he added, such as people who arrive injured.
Prisoners are seen by a registered nurse upon arrival, and charts are later reviewed by physicians. CNCC officials said they also push hard for public health within the facility, including cleanliness and hygiene, during regular tours of the facility with medical professionals.
“It's worked extremely well and continues to evolve,” Thomson said, who noted that is something he has never been required to do before in his career.
Skillen said prison medical staff regularly bungled his medication.
“It didn't surprise me,” Skillen said. “If they screw up with me, I'm young. And if you didn't remind them about what you needed, you didn't get it.”
Skillen said the nurses were personable, though they did seem overtaxed.
“I liked the nurses, they were very young, mostly under 30, fresh out of school,” he said. “But they were stressed out. They didn't want to put you off, but they had to prioritize.”
During one 20-minute visit through the thick glass, Storring-Skillen said her son put down the phone and began peering into the corner. He said he saw a skunk, and was walking into walls.
“It would have been funny but he really saw it in the corner,” said Storring-Skillen, who chalks up the encounter to a bad reaction with the wrong drug. She said her son was receiving generic forms of medication, which was likely having an adverse reaction with his pain medication, distorting his perception.
Even Skillen suspected something was amiss.
Thomson said different doctors have varying views on medication, and generic forms of drugs are used regularly in jail.
“With the ministry of corrections, as far as health-care services, everything is policy developed,” he said, and nursing care falls under the College of Nurses. “(With medication) it's whatever is available in the community.”
Dispensing and accountability, and ordering and drug-control practices all fall under ministry regulations, Thomson said.
“Some of the medications are extremely expensive,” said Thomson, such as to treat HIV. “What the doctors will do here, for example, if an offender's on a medication in the community, they would review that to see if they need that particular medication and that dosage.”
All medical expenses come out of the per-diem rate agreed upon by both Management and Training Corporation (MTC) and the province, he said, even though medical service is subcontracted to First Correction Medical, also an American company.
A portion of medication costs is paid for by the Ontario Health Insurance Plan (OHIP).
“The ministry monitors all of the drugs we use here at the facility,” Thomson said, adding a lot of times MTC buys its medication from the same facilities as where the government gets its drugs.
Mount added that different doctors have varying opinions about which medications work best for various ailments, which is no different inside the jail. With a change in medication, Mount said “an individual may make the assumption as to why it was changed. Ultimately, our doctors are under the legal obligation and share the responsibility to make sure that continuity of health care remains a priority,” he said. “It's not a cost issue, and we're making sure we're maintaining quality of health.”
The possibility of addiction is just one of the reasons a certain medication may be dropped.
“It doesn't have to be an illegal substance, it could just be heavier drugs like prescription drugs,” said Thomson.
“One of the things that we believe in is trying to cut the habit... (and) reducing the use of those types of medications,” Thomson added.
Doctors will look at what the prisoner is on, how long they've been on it, and whether there's a plan is place to get them off it, he said, especially if it's addictive.
Thomson said both MTC and the ministry are constantly reviewing the cost of medication, and brand names versus generic companies.
Ultimately, those calls are made by physicians, he said, and there are numerous control mechanisms in place to govern which medications are used.
Prescription drugs are only available on the medical unit. There are “tight” procedures, for example, around the availability of methadone, said Thomson. For lesser drugs, like Tylenol, inmates earn the right to have those products in their cells as part of a self-medication program.
Harder drugs are dispensed in the medical unit and staff ensure inmates swallow the pills, he said.
Skillen at CNCC on explosives possession
Now 25 years old, Skillen was convicted and sentenced in February 2003 for making explosives for the purpose of endangering lives, and the possession of explosives. On top of five months of precustody, he was sentenced to 18 months in jail with a 10-year weapons prohibition and three years probation which ends in March 2007, as well as keep-the-peace provisions and Internet supervision.
Despite what the Crown attorney said in court, Skillen maintains that he was suicidal when a bomb exploded in his hand, and he says he had no plans of killing anyone other than himself, contrary to the Crown's argument.
“I didn't agree with it,” Skillen said. “It's in the past now and... I've accepted my fate.”
In court, the Crown attorney said “we believe he planned to harm students who travel on that path from nearby Barrie North (high school),” adding Skillen had made several threats to shoot and kill students in the past.
In 2001, Skillen was convicted of public mischief after an investigation found he had expressed intentions of blowing up Durham College. In 1997, Skillen was charged for possessing explosives, receiving a conditional sentence.
Coming to CNCC
Following emergency surgery in London, Skillen was transported to Penetang and was initially locked up in CNCC's medical unit, and despite pleas to eventually be released into the general population, the request was denied because he was told his hand wound was considered a dangerous weapon because it contained pins and a brace.
Once the injury had healed by mid-March, he was allowed to roam the range with other prisoners. Part of March and all of April, 2003, were spent in general population.
Compared to time spent in other facilities, Skillen said CNCC was the worst.
“It's like night and day — you don't know unless you go through it,” he said. “I got fully used to it, but it is a way of life.”
Preceding Skillen to CNCC was his reputation. While most inmates are up on more common charges like assault or theft, he was known upon arrival as the kid who blew off part of his hand with a homemade bomb.
“You say you're in for explosives and you're instantly a celebrity,” Skillen said. “But boredom was the main enemy of us all.”
At the end of October 2002, Skillen was transferred next door to the Penetanguishene Mental Health Centre for a 30-day psychiatric assessment, where he was deemed criminally responsible for his actions.
“I thought I had landed in heaven (at PMHC) compared to CNCC,” he said. “OCI and PMHC shared a common trait in that they're there for rehabilitation.”
Skillen's bipolar condition wasn't officially confirmed until his stay at PMHC. For many years leading up to the bomb incident that changed his life forever, Skillen had been diagnosed with various disorders, from a chemical imbalance to anti-social behaviour. Delayed diagnosis only exacerbated his condition, he said.
“With one person saying one thing, and another person saying something else, it's frustrating,” Skillen said. “You need to know what the problem is to know how to deal with it. Different problems have different remedies.”
Storring-Skillen was so upset with her son's treatment while at CNCC that within a month she penned letters to CNCC's health-care co-ordinator. In her January 2003 letter, she complained that her son wasn't receiving promised physiotherapy or proper medication which had worked well for him during a stint at PMHC.
She also said her son was not treated for a throat infection, and that his dental and bodily hygiene was being neglected.
Skillen refers to CNCC as a “human warehouse,” but Thomson says that's extreme.
“If you lock people up and offer them nothing, you're not doing them any service, you're not doing the public any service,” Thomson said. “You cannot just throw them behind doors and do nothing, because then you're just creating a negative environment, which is already bad enough.
“You have to create opportunities for change.”
Those who break the law should know they're going to be incarcerated, he added, to protect society from people offending again.
“You can't just stop there. You have to look at the whole justice system, and what can you do to reduce (crime). Whether or not we're warehousing people here... it's a big facility.”
How does the ministry handle inmate issues?
“The inmates have access to a formal complaint process,” said Victoria Broughton, spokesperson for the Ministry of Community Safety and Correctional Services.
If an inmate has a dispute or concern regarding correctional services or a specific institutional operation, the inmate can voice their complaint in many ways.
Options include a verbal complaint to the facility administrator or shift supervisor, the provincial ombudsman's office using the confidential mail or telephone system, the Ontario or Canadian branches of the Human Rights Commission, or their local MP or MPP. They can also write to the regional director or deputy minister of the pertinent ministry, or seek legal counsel.
If an inmate's concern is related to records, the prisoner can make a request through the Freedom of Information Act, said Broughton. In extreme cases, inmates can commence civil proceedings versus correctional services.
“Those are some of the avenues available to inmates,” she said.
If a complaint is received the ministry must respond in a “timely” manner, said Broughton, which could depend on a possible investigation or other factors.
Serious medical complaints are forwarded to the ministry's senior medical consultant, she said. Overseeing health-care standards at provincial prisons are a senior medical consultant and a senior nursing consultant, who review and write policy for the ministry.
Policies are reviewed regularly, she said.
Dr. Paul Humphries, the ministry's senior medical consultant, could not be reached for comment.
Broughton stressed that policies are not only in regards to CNCC, but all provincial prisons.
“This is policy... for all facilities,” said Broughton.
The ministry does not keep statistics on inmate complaints, she said, “the reason being we don't have a universal repository for complaints.”
Because of numerous options an inmate could take, there could be sundry forms undertaken, which would make it difficult to track, she said.
Although the Ministry of Health and Long-Term Care does not oversee prison medical care, consultants are members of various medical colleges, such as the Ontario College of Physicians, and the Ontario College of Nurses, said Broughton.
“These consultants we employ are members of these colleges,” she said. “That's how (policies) are developed in the consultation process.”
Any complaints raised by prisoners usually find their way to the desk of Clare Lewis, Ontario Ombudsman. His office is responsible for addressing issues regarding — for the most part though not exclusively — provincial ministries. The independent arm of government has received complaints from inmates at CNCC, though the number of incidents is unclear. Lewis visited CNCC last year, though spokesperson Gail Scala could not confirm how many times he has been there.
The ombudsman's annual report wants prison officials at all jails to ensure inmates are medically treated in a “timely” manner, a loose term but one that often hinges on the severity of a prisoner's malady, said Scala.
“One of the health-care issues and complaints was regarding delays in providing medical attention, and when we say timely it means a response to an inmate within a timeframe that's appropriate,” said Scala, or before the ailment becomes too much of a problem.Source: www.midlandfreepress.com For more info: Citzens Against Private Prisons www.capp.50megs.com