Sign the Open Letter on Healthcare in Prisons

Sign the letter here:

Read it below:

Sylvia Jones, Ministry of the Solicitor General (SOLGEN)
Christine Elliott, Ministry of Health and Long-Term Care
Linda Ogilve, Manager of Corporate Healthcare, SOLGEN
Beth Dunford, Manager, Healthcare Planning & Performance, SOLGEN

We are writing on behalf of the University of Ottawa Prison Law Clinic that works with the Jail Accountability & Information Line (JAIL), which is a hotline serving people incarcerated at the Ottawa-Carleton Detention Centre (OCDC), and the Elizabeth Fry Society of Ottawa Board of Directors. The University of Ottawa Prison Law Clinic receives calls twice a week from people incarcerated at OCDC under the supervision of Savannah Gentile, Barrister and Solicitor. The Elizabeth Fry Society of Ottawa supports and advocates for women and non-binary people who are criminalized, at risk of criminalization, or have been previously criminalized through prison in-reach, court support, transitional housing, housing support, counselling services, a family centre and access to basic needs/supplies. Our organizations have become increasingly concerned with the long standing access to healthcare issues facing those incarcerated in Ontario’s provincial institutions, particularly OCDC.

We are writing in order to draw your attention to the healthcare crisis reported to us by countless prisoners at OCDC. Our concerns have become particularly urgent in the past few weeks following a COVID-19 outbreak at OCDC where dozens of prisoners and several staff tested positive for the coronavirus. Just as this outbreak at OCDC became public, we learned that the Community Advisory Board would be dismantled. Given the exigent nature of the healthcare problem, and consistently decreasing oversight of carceral facilities in Ontario, our teams would like to offer both short- and long-term recommendations for change. We are particularly concerned that:

  • Prisoners are being denied their basic right to adequate and consistent healthcare due in part to the limited nursing and physician complement;
  • The Ministry of Health and Long-Term Care (MoHLTC) has been collaborating with the Ministry of the Solicitor General to develop a Correctional Healthcare Strategy while experts and advocates have long been asserting that the MoHLTC could increase healthcare accountability and ensure that healthcare services are delivered in compliance with professional standards of practice by assuming responsibility for provision of healthcare and delivery of public health programs in Ontario provincial institutions;
  • Individuals are being held in Ontario jails when non-custodial alternatives could be made available, including during the pandemic where those held in custody are put at increased risk of contracting COVID-19. This puts prisoners at risk following their eventual release – exacerbating the existing pressures faced by Ontario’s public health system;
  • Women are being disproportionately affected by poor healthcare while in custody;

The current healthcare reporting structure within Ontario jails limits the autonomy and clinical independence medical professionals require to do their job by requiring medical professionals to report to institutional staff with security priorities. A nurse attested to this at the inquest into the deaths of Floyd Deleary and Justin Thompson at the Elgin-Middlesex Detention Centre, testifying that “as a nurse, security was the primary focus and healthcare was a secondary concern”. Under the guise of “medical monitoring”, people incarcerated at OCDC have reported that staff refuse shower time, exercise, and some medications while they are on quarantine, placing them in segregation.

In response to these issues we demand that the Ministry of the Solicitor General take the following measures:

  • Take urgent and effective measures in collaboration with other ministries to divert people from incarceration and to decarcerate OCDC in recognition that prisons are not therapeutic institutions and harm the health of incarcerated people;
  • Ensure that the healthcare department is sufficiently staffed to accommodate the complex and numerous needs of prisoners;
  • Consider increasing healthcare staff salary and incentives to improve staff retention; and
  • Hire more than one doctor, and particularly a woman doctor, to respond to the needs of women prisoners at OCDC.

The Current Law on Healthcare in Provincial Jails

Despite legal and human rights obligations, prisoners in Ontario are not afforded the same rights and access to healthcare as the general public. Healthcare services in provincial jails and prisons are delivered by the Ministry of the Solicitor General (MSG) rather than the Ministry of Health and Long-Term Care. The superintendents of provincial jails and prisons are responsible for the health and safety of its prisoners.

Under the federal Canada Health Act, the primary objective of health care policy in Canada is to “protect, promote and restore the physical and mental well-being of residents of Canada”, including prisoners. The Human Rights Code also protects the rights of prisoners by recognizing the dignity and worth of every person in Ontario. The Code provides equal rights and opportunities for all without discrimination, including the right to equal treatment with respect to services in Ontario. In addition to our domestic laws, there are international human rights standards to ensure prisoners are treated with dignity and respect. The Nelson Mandela Rules state that at minimum, “prisoners should enjoy the same standard of health care that are available in the community…without discrimination on the grounds of their legal status.”

Currently, the inadequate practices and procedures in place to deliver healthcare services to prisoners in Ontario contradict Canada’s public health objectives and international human rights standards by depriving prisoners of the right to access adequate healthcare services. Ontario is one of the few provinces in Canada still permitting prison authorities to oversee healthcare for incarcerated individuals. Alberta, British Columbia, Newfoundland and Labrador and Nova Scotia have integrated healthcare in provincial prisons with the public health care system. This integration is intended to ensure continuous and uninterrupted healthcare services for individuals before, during, and after incarceration, which ultimately contributes to a healthier society overall.

Now more than ever, in the midst of a global pandemic, Ontario needs to rethink its policies and procedures as it relates to healthcare services in provincial jails and prisons. Institutional healthcare services must be delivered by independent and external decision-makers, who are qualified healthcare and medical professionals, without interference by security agents and protocols. Since the MSG cannot provide a standard of care tantamount to that offered in the community, they and other authorities ought to release people whose healthcare needs cannot be met. Prisoner healthcare is currently in the hands of the wrong ministry, particularly because the primary concern of MSG is security and order within their sites of confinement, not healthcare services. The responsibility of healthcare should be transferred to the Ministry of Health and Long-Term Care as a step towards ending the systemic negligence of the physical and mental health needs of prisoners in Ontario.

The Health and Wellbeing of Prisoners Affects the Public Health at Large

Incarcerated individuals are a population put at-risk, and are often criminalized due to their physical and mental health and abilities. They have a higher prevalence of physical and mental health issues, and carry a higher burden of illness than the general public. To demonstrate the gravity of the situation, people in custody are 2-3 times more likely to have been diagnosed with a mental illness or deemed to have substance use issues.

Healthcare in jails and prisons is a public policy consideration for our society as a whole. Since most provincially incarcerated individuals will eventually be released back into the community, it is even more crucial to provide prisoners with the adequate care to maintain their health in custody. Imprisoning individuals living with health issues and then releasing them into communities in worse health will only exacerbate the existing pressure placed on our public health care system. Furthermore, improved prison healthcare will also contribute to a reduction in re-engaging in criminalized acts after release.

The continuity of healthcare services before, during, and after custody is also essential to protect public health at large. We have received reports that upon admission into OCDC, the jail suspends prisoners’ medication or substitutes for it with cheaper medications to treat their existing health conditions, causing their health to decline while in custody. The inconsistency between in-community health services and prison healthcare services makes it impossible for prisoners to continue their existing medical regimes. Once prisoners are released, it becomes more difficult for them to re-enter society because they have not received sufficient healthcare while in custody and they were unable to access those services in the community through temporary absence passes. If prison healthcare services are transferred to the Ministry of Health and Long-Term Care, prisoners will be able to better re-enter society once they are released back into the community. As such, eliminating the gaps in healthcare by providing consistent services will ultimately create a healthier society overall.

Inadequate Healthcare Disproportionately Impacts Women

Inadequate service provision of healthcare disproportionately impacts incarcerated women. Reproductive health is uniquely experienced by women, requiring specialized healthcare provision. Incarcerated women are more likely to have experienced sexual violence than the general population and are 20 times more likley to die by suicide than women in the general population, and more than twice as likely as incarcerated men to have attempted death by suicide. Currently, one doctor – a man – serves the entire population at the 585-bed jail, including women prisoners at OCDC, and the healthcare manager position was vacant for almost 7 months during the pandemic before being filled.

Over the past decade, a number of preventable health crises at the institution have had devastating and irreversible impacts on women’s lives. In 2012, a 26 year old pregnant woman who was incarcerated at OCDC was refused medical attention when she informed nurses that she was in labour, until it was too late to take her to hospital. She gave birth to her first child, confined in a cell, as prison staff watched. One year later, her baby died due to health complications related to birth and a $1.3 million lawsuit against the jail was launched. Additionally, another woman living with mental health illnesses and suffering from breast cancer, was subjected to more than 200 consecutive days of segregation rather than receiving adequate healthcare. A lengthy list of recommendations followed the Jahn Settlement Order, and subsequently OCDC has repeatedly been found in violation of the Order.

Callers to our prison law clinic and the JAIL hotline report ongoing similar conditions of confinement in which criminalization and lack of access to adequate medical supports result in disproportionately negative healthcare experiences. It is imperative that these conditions are immediately remedied, and that women at the institution be decarcerated from custody or provided with access to safer care from a woman identified doctor when release is not pursued.

Healthcare Professionals Require Autonomy in Institutions of Confinement

Sites of confinement pose additional health risks to prisoners due to being inherently detrimental and violent environments with unhealthy living conditions and limited resources. As a result, the health needs of prisoners are “layered, chronic and often poorly addressed”, which makes providing health care to prisoners extremely complex. We believe that providing adequate healthcare in prison settings is impossible. In this letter, we present the proposed solutions below as means to alleviate some of the harm caused by incarceration, while recognizing that prisons can never be therapeutic.

The MSG and superintendents lack the requisite knowledge and expertise to deliver, manage and oversee the healthcare needs of prisoners. They are tasked with the responsibility of maintaining safety and order within jails and prisons, while being simultaneously expected to deliver healthcare services, which they are unable to adequately provide. The work of healthcare staff at the OCDC and other provincial sites of confinement is mediated by jail officers. We confirm that jail officers and management hamper healthcare delivery within the institution as they often have the last say on who can and who cannot access healthcare services.

There are several reports where doctors, personal support workers, and other healthcare professionals summon a patient only to be denied for many reasons, including arbitrary and subjective decisions by jail officers. When the OCDC Healthcare Manager position was unfilled, we heard reports about Deputy Superintendents, who are untrained in healthcare, taking on some of the roles of a healthcare manager. Furthermore, on many nights, OCDC officers were the ones delivering medication to imprisoned patients as healthcare staff shortages continue to plague the Ottawa jail. Putting unqualified jail officers in the role of healthcare providers is unacceptable public health policy. As such, independent and autonomous decision-making by qualified medical professionals is imperative to promote the health of prisoners.

Medical professionals, healthcare organizations and ombudspersons have all reiterated the importance of distinguishing the roles of healthcare providers from security personnel in prisons. Firstly, clinical independence and autonomy of prison healthcare professionals would mean that “clinical decisions could not be overruled or ignored by non-medical prison staff.” This is particularly important to ensure that the qualified professionals are able to properly diagnose and treat their patients without interference by other staff. The College of Family Physicians of Canada has also stated that the autonomous delivery of healthcare services in prisons would mean “less conflict between health personnel and corrections authorities”, which would permit healthcare professionals to have “more regular exposure to the values and ethics that guide usual practice.”

The importance of clinical independence in prisons is also recognized internationally. As noted by Dr. Ivan Zinger, the current Correctional Investigator of Canada, healthcare autonomy inside prisons needs to reflect the Nelson Mandela Rules, which establish that every prison shall have a healthcare service that consists of “an interdisciplinary team with sufficiently qualified personnel acting in full clinical independence.” Furthermore, the World Health Organization (WHO) has published a policy brief to help governments identify the best practices for prison healthcare. Among other important principles, the WHO establishes that healthcare personnel in prisons should “act in their professional capacity completely independent of prison authorities and in the closest possible alignment with public health services.” Notably, when British Columbia reformed its prison healthcare system, it explicitly incorporated the WHO’s approach to independent healthcare service delivery. A more equitable and therapeutic prison healthcare system is impossible without more access to community-based organizations, which need to be given regular access to OCDC and the prisoners they serve as patients.

Vacant Healthcare Positions at OCDC, Healthcare Requests Being Ignored

We have recently learned that, from at least the summer of 2020 until March 2021, there was no Healthcare Manager or Assistant Healthcare Manager at OCDC. We have heard that there was only one deputy in charge of healthcare at OCDC while the healthcare positions remained vacant for almost one year. The severe understaffing of qualified medical personnel at the jail has led to prisoners being denied access to green forms to request medical care because there is no one to review them. Those who previously sent in repeated requests to the healthcare manager, doctor, or nurses have gone ignored. Prisoners have reported that nurses and the doctor at OCDC are incapable of handling the overwhelming volume of medical requests from prisoners. They have been told that the lone doctor simply cannot take care of everyone in the jail and their requests will not be addressed unless they are “urgent”.

In addition, we have received reports of extremely disturbing and neglectful behaviour by jail staff, including:

Individuals with serious health conditions who are either receiving the wrong medication or are not receiving them on time, if at all;
Some individuals have been left with open wounds to bleed on their unchanged bedsheets for days;
Some jail officers have resorted to placing prisoners in segregation to “monitor” their medical conditions because they are short-staffed and ill-equipped to deal with medical needs;
Staff are not taking temperatures as per COVID-19 protocols;
Water taps in some cells are broken and prisoners are told to drink from the toilet;
Soap, toilet paper, and towels are scarce and prisoners have resorted to using dirty towels to wipe their feces, towels which remain in their cell for days at a time;
Shower time is often being denied, and showers are not being cleaned; and
Exercise time is regularly being denied, resulting in weight gain and exacerbating mental health issues.

This unspeakable situation is a clear example of why prison authorities like the Ministry of the Solicitor General should not be responsible for playing a dual role in maintaining institutional order and security, while also having the responsibility of providing medical care to prisoners. The conflicting mandates mean the former concerns routinely trump the later, resulting in the complex needs of prisoners going unmet.

To reiterate, we recommend that SOLGEN take the following actions at OCDC:

  • Take urgent and effective measures in collaboration with other ministries to divert people from incarceration and to decarcerate OCDC in recognition that prisons are not therapeutic institutions and harm the health of incarcerated people;
  • Ensure that the healthcare department is sufficiently staffed to accommodate the complex and numerous needs of prisoners;
  • Consider increasing healthcare staff salary and incentives to improve staff retention; and
  • Hire more than one doctor, and particularly a woman doctor, to respond to the needs of women prisoners at OCDC.

Yours sincerely,

University of Ottawa Prison Law Clinic
Jail Accountability & Information Line
Elizabeth Fry Society of Ottawa Board of Directors

Christian Richer, Superintendent (Acting), Ottawa Carleton Detention Centre
Amy Fisher, Strategic Advisor, Ministry of the Solicitor General
Ena Chadha, Chief Commissioner, Ontario Human Rights Commission
Paul Dubé, Ontario Ombudsman
Gilles Bisson, Critic – Correctional Services, New Democractic Party of Ontario
Lucille Couillard, Critic – Solicitor General, Liberal Party of Ontario
Mike Schreiner, Leader, Green Party of Ontario
Senator Kim Pate