Medical Situation in Pollsmoor Prison: briefing

Correctional Services

01 October 2001
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Meeting report

CORRECTIONAL SERVICES PORTFOLIO COMMITTEE
2 October 2001
MEDICAL SITUATION IN POLLSMOOR PRISON: BRIEFING

Chairperson:

Mr Fihla (ANC)

SUMMARY:
The Committee was briefed on the medical situation currently faced by Pollsmoor Prison.
The delivery of medical services to prisoners is integral to transformation.

MINUTES:
Mr Fihla (ANC) stated that the Department faced critical challenges such as rehabilitation and the health of prisoners.

Presentation by Dr Craven
Dr Craven said that all prisoners were entitled to medical care. He provided medical care to Pollsmoor prisoners through his private practice. If prisoners wished to see him, orderlies first assessed the case. Inevitably many prisoners that actually needed to see him did not get the chance to see him. Conversely, he said that he would spend most of his time treating prisoners with trivial diseases because he did not have the time, or the resources, to devote himself to the more seriously ill prisoners (with illnesses such as Tuberculosis or Depression).

For the past two and a half years, he had worked through the proper channels such as, the regional or the head offices,seeking help but to no avail. He said that with the full knowledge of the orderlies and nurses, he had kept a daily list of all his instructions that had not been carried out. For instance, prescribed drugs not reaching patients; prisoners not being sent to hospital on time; and delays in medical reports making their way to his attention. His pleas for assistance had fallen on deaf ears and he was frustrated by this fact.

In June 2001, the Minister of Correctional Services acknowledged his pleas, but did not respond to them. The inspecting judge was supportive but the only consolation offered was the knowledge that the situation was much worse up country. More complaints about medical problems were received up country than elsewhere in the country. However, Dr Craven was not satisfied by the efforts that were being made. Hospital workers such as nurses had become increasingly demoralised and less efficient. Thus the situation was cause for great concern.

Recommendations
The recommendations made by Dr Craven were divided into: -
what could be done immediately
what required time to be carried out
In his opinion, changes that could be made immediately were more relevant because it would take short-term changes to bring about long-term results.

Lack of Discipline
The most serious problem was the lack of discipline found in prisons. In May 2001, he had visited Atlanta, USA. He visited several Georgia State Prisons, and the discipline impressed him greatly. For instance, prisoners called all authoritarian figures " Sir", and they would even ask for "Permission to speak". This level of discipline could not be found here in South Africa. Giving the example of a situation he witnessed earlier this year, he said that when exit gate was locked the warden and the Governor had to push through the prisoners to leave. In his opinion, discipline was a major problem in our prisons, and he felt that it should be rectified immediately.

Cleanliness
Improving cleanliness is essential. Prisons were filthy. For example, in September 2001, Pollsmoor had an outbreak of dysentery. One out of ten toilets were working. In addition, 50 prisoners were kept in a cell for 20 prisoners, with only one toilet and shower. The toilet was not flushing and water had to be thrown into the bowel in order to get rid of the waste. Raw sewage and spilt food were on the floor of these cells. Thus it was his suggestion that prisoners were given brushes to keep their living conditions clean themselves.

Maintenance
The lack of maintenance in the prisons was disturbing. For instance, there were broken windows and tiles. All this was encouraging germs to breed. In overcrowded situations, the fear of menigococal meningitis was of great concern. In 2000, there was a scare of this disease in Pollsmoor Prison, but fortunately the injured person did not have it. Without any improvement in the living conditions as they currently stood, the disease would eventually be able to take root.

Personal cleanliness amongst the prisoners was not enforced in the prisons. This led to the breeding of ectoparasites (such as lice and fleas). Personal cleanliness had to be enforced as well.

Smoking
One of the greatest causes of ill health in Pollsmoor was tobacco. If the prison were a no-smoking institution, it would be a far healthier place. Even when he ordered no smoking cells for the prisoners that did not smoke, rarely was the instruction ever carried out. Dr Craven stated that in terms of the Tobacco Controls Act of 2001, prisons should be included as government departments, and thus the smoking laws should be enforced. This view was supported by many.

In Georgia, all prisons were non-smoking. Smoking was only allowed during certain times. If such a position could be enforced in those prisons, there was no reason why the same thing could not happen here in South Africa.

Employment
Most prisoners sat around all day unoccupied. All prisoners should be given work according to their physical or mental capacity. This was not to punish the prisoners, but to keep them busy.

As an aside, he explained that there were three groups of prisoners:
-the BAD, such as murderers
-the MAD, such as the psychotic prisoners
-the SAD, such as the social inadequates
The vast majority of prisoners were sad. It was for this reason that he felt that they should be out there doing something such as sweeping streets. This called for a structured and disciplined caring environment that allowed the prisoners to work, but that this was not presently happening.

Nursing Staff
There was a need for fewer prisoners and better-trained nurses. For the long term, he felt it would be necessary to consider who would provide the medical care. Dr Craven suggested one of three options:
-Privatising all prison medical care. Although this did have its dangers, for instance, at a medical conference he attended in Finland last year, he read a paper by a US prison stating that it had privatised medical care. Nevertheless, the paper expressed concern with the fact that the shareholders were impacting upon the level of care. This is because doctors would be compensated more highly for keeping their costs down. The result was that many prisoners were not treated.
-Transfer all medical services to the province.
-Transfer the medical services to a medical school or to a partnership between the medical school and the province (as in Georgia State Prisons).

Discussion
Mr Bloem (ANC) asked how long Dr Craven had been working at Pollsmoor Prison.

Dr Craven said that he had been contracted to work there for the past thirteen years.

Mr Durand (NNP) thanked Dr Craven for his presentation. Was there a 'cover up' at Pollsmoor? A few months ago, the Committee made an inpromptu visit to the prison. He said that they were kept in an office whilst things were put in place. Was Dr Craven aware of this, because after the visit the Committee got the impression that the situation was under control. However, the presentation had indicated that the situation was not under control.

Mr Bloem (ANC) felt that this was a one-sided briefing by Dr Craven, and it would require calling, for instance, the head of the prison and provincial commissioners, in order to do justice to the matter. This would thereby enable other parties that were involved to give answers to some of the questions.

Mr Durand (NNP) retorted that given the fact that Dr Craven had the courage to present on his own, he should be able to answer whatever questions he was asked. Other interested parties could be called in at a later stage.

Mr Fihla (ANC) said that he was there that day. A delegation of nurses and staff tended to them and did not hide anything. They informed the Committee of the terrible situation.

Ms Dlamini (ANC) commented that she thought Dr Craven would give a brief of the work he had actually done in the prison. His presentation did not give a clear picture of this.

Mr Fihla (ANC) suggested that the Committee was looking for a picture of what was happening in the prison. The point of this meeting was not to grill Dr Craven, but to get his insight and to give him a chance to offer solutions.

Mrs Seaton (IFP) asked how often reports were submitted and to whom they were submitted so that the Committee might access them if necessary.

Dr Craven explained that every prisoner had a medical record, which was kept separate from the discipline record. He would give instructions for the patient on the report. However, his major problem was that in many cases the written instructions were not carried out. He had kept a daily record of failures over the past two and a half years, and that a copy would be left behind for the nurses. Thus he had evidence to support his allegations.

Mrs Seaton (IFP) enquired if the problems in the prison, such as the broken toilets, were committed to a report that would be given to the Governor.

Dr Craven said that the public health matters such as Tuberculosis were brought to attention. In addition, and in accordance with the law, cases of Dysentery were brought to the attention of the Health Inspector. However, he could not say whether the information would go as far as the Governor, because he could do only what he was required to do, which was go through the proper channels.

Mrs Seaton (IFP) asked whether he did not have direct access with the Governor.

Dr Craven explained that in the old days he would deal directly with the Governor. However, he did not have this access under the present management.

Mr Oosthuizen (ANC) accepted the ruling to afford Dr Craven the opportunity to share his experiences in Pollsmoor over the last thirteen years. However, he expressed concern with what was heard in the meeting because after visiting prisons such as Pretoria Central, or C-Max, the factors mentioned in the presentation did not exist. It was not fair to compare our prisons to those in Georgia, because what South Africa was facing was a unique situation. The problem was overcrowding, and that this was commonly accepted. Overcrowding implied that either the Criminal Justice System was effective, or that it was not effective. However, he was not going to engage in a political debate over that.

Mr Oosthuizen (ANC) requested that Dr Craven share more of his views regarding the transfer of the medical services. It would be grossly unfair to make comparisons with Georgia State Prisons, and it was necessary to get to the 'nitty gritty' of the South African problem. He asked for a suggestion that would eliminate the problem holistically, and that would benefit the entire Republic.

Mr Fihla (ANC) added that the comment made had been very constructive.

Dr Craven explained that he took the point of comparing on an international scale. However, he said that while he was in Georgia, he visited the flankship prisons as well. Regarding medical arrangement, what was suitable for Cape Town was not necessarily suitable for the other provinces. Thus local rules had to be made by local people.

As far as Pollsmoor was concerned, the problem was that the prisoners had to seek medical care outside the prison. Thus an advantage of privatising would be the reduction of medical costs. However, he explained that there were two arguments against this:
-The political argument - why should prisoners be afforded better medical care than the average man in the street?
-Privatised secondary care if carefully monitored is more effective than dealing with provincial specialists. It would be possible to persuade provincial specialists to visit the prison on regular intervals, although this was not a very popular option.
-Complete privatisation would mean that doctors would be responsible to the shareholders and not to the patients.
He concluded that there was also a responsibility in the prison department to consider security because high-risk prisoners would need to be monitored.

Mr Fihla (ANC) made a comment. Many of the Committee members had visited several prisons. For instance, he was recently in New Zealand, Canada and Denmark. These countries were far more advanced and that it would not be possible to copy everything from them because of the constraints in South Africa. However, he did take a few factors that would be possible to copy, such as demilitarised prisons in South Africa. Many innovations were introduced in South Africa in order to change the Criminal Justice System.

Presently in South Africa there were many prisons, like those overseas, such as in Malmesbury, Bloemfontein, and in the Northern Province. They all served as model prisons because of the combination of privatised and public sectors. These could serve as a mirror for the other prisons.

Mr Fihla (ANC) said that having visited many prisons through South Africa, Pollsmoor was facing a clear situation of terrible management. There were differences in all the prisons, and that some were better managed in terms of health. It was for this reason that it would be necessary to copy the prisons that had improved in the face of difficult situations.

Mr Fihla (ANC) concluded by saying that the short-term considerations mentioned by Dr Craven would be followed. Those issues could be altered if the prison was monitored. As far as the long-term solutions would require further discussion at a later stage.

Mr Bloem (ANC) asked if the Minister of Correctional Services was aware of all the problems.

Dr Craven replied that he did not know if the information had gone as far as the Minister but it was acknowledged in June 2001.

Mr Durand (IFP) asked if the problems faced by Pollsmoor Prison could ever constitute a medical problem to the people of the Western Cape if they were not attended to quickly.

Dr Craven said this would eventually happen because health in and out of the prison went together.

Mr Diale (ANC) said that Dr Craven had mentioned two important factors. There were two categories of prison medical staff, namely wardens and nurses. Why were his instructions not followed? Was it due to a lack of change of mind-set, or simply something that did not please the workers? He felt that there had to be a reason for the breakdown.

Dr Craven explained that he believed that it was a combination of too many prisoners and too few staff, and the concomitant lack of discipline.

Ms Dlamini (ANC) enquired about the number of HIV and TB patients in prison. How many of them had visited the hospital in a week.

Dr Craven said that he could not say how many patients there were off hand. However, the figure was available.

Ms Dlamini (ANC) referred to the issue of overcrowding. Other prisons had been innovative, what had they done to find a strategy? The situation called for a multi-pronged approach.

Dr Craven explained that he would go to the hospital five days a week, and sometimes on Saturdays if there was a backlog. He was rarely invited to management meetings, and the only one that he was invited to was cancelled without his knowledge. It was clear that the medical matters were very low on the priority list of Pollsmoor Prison. However, this was not surprising given the fact that correctional services were about correction and not medicine. He felt that it was for this exact reason that the medical care had to be taken out of the hands of the prison.

Ms Dlamini (ANC) asked what Dr Craven would do if the inmates were not given medication.

Dr Craven said that all he could do was complain because he did not have the authority to order anyone to do anything.

Mr Durand (NNP) said that the conditions in Pollsmoor resulted from bad management. He wanted to know whether the good days were prior to 1994 or to the appointment of the new Governor.

Dr Craven said that it was a gradual deterioration, to which a date could not be put.

Mr Diale (ANC) enquired about what the Governor was doing about the lack of discipline.

Dr Craven replied that the Governor did not take him into his confidence and so he could not comment on the steps taken by the Governor.

Mr Oosthuizen (ANC) asked if the problems were restricted to Pollsmoor, and if Dr Craven would speak to counterparts in other prisons regarding the matter.

Dr Craven explained that he met with, and exchanged notes, with other doctors every two months. He had heard that conditions up country were bad. This is the position he had picked up as a result of hearsay. However, he knew that this information was receiving the attention of the medical association.

Mr Bloem (ANC) asked if the lack of discipline was amongst prisoners and wardens.

Dr Craven replied that the discipline problem applied to both groups of persons.

Mr Bloem (ANC) asked for clarification with regards to exactly whom the 'Governor' was.

Dr Craven said that in using that term, he was referring to Mr Freddie Engelbert (in charge of the administration), and Mr John Jansen (the head of maximum security). He apologised for any confusion caused by using the term 'Governor', and explained that this is the term he had become accustomed to using.

Mr Fihla (ANC) said that the Committee had exhausted the possible questions that could be posed before the doctor. Dr Craven had been invited in an attempt to obtain the whole truth relating to the situation. There was great concern surrounding the situation in prisons throughout South Africa, and that the Committee had visited a number of prisons for comparison.

Some of the prisons had better health management such as the Free State. However, he explained that the task of the Committee was to deal with short-term solutions that could be easily addressed as a starting point. The long-term solutions would have to be decided in corroboration with management, the Ministry and the Department. He concluded by suggesting that Dr Craven visit other prisons throughout the Republic in order to form a personal comparison.

The meeting was adjourned.

 

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