REPORT OF THE PORTFOLIO COMMITTEE ON CORRECTIONAL SERVICES ON HEALTH CARE FACILITIES IN POLLSMOOR CORRECTIONAL CENTRE

1. Background

1.1 The Portfolio Committee has had a number of comprehensive briefings on health care facilities from the Department, most recently on 12 September 2006. On this occasion, the Committee was briefed on the HIV/AIDS Prevalence Survey and questions were raised about the capacity of the Department to deal with the pandemic, and the opportunistic diseases that often accompany it.

From their very nature, prisons are environments in which communicable diseases can spread. Most correctional centres are overcrowded, and some are seriously so. Many inmates that are admitted are already ill and/or malnourished.

1.2 In the course of 2006 and 2007, the Chairperson and other members of the Committee received communications from a number of health professionals working at Pollsmoor complaining about the facilities, working conditions and equipment in the hospital sections. While the members of the Committee encouraged these complainants to take their concerns to the relevant levels of management, one such complainant wrote:

“Management lack leadership skills, do not consult. They do as they please, do not follow procedures, are autocratic, using the same tactics as the previous government. If you do not play their music tune, you are either suspended or transferred to another prison.”

In another place, this person says:

“The management is fully aware of these conditions, but are very good at covering their wrong deeds. If you were to try and expose them, they would either suspend or transfer you to another management’s area, be you a member or inmate.”

1.3 It was therefore decided that a delegation of the Committee would visit the Pollsmoor hospital sections in the Admission Centre and Medium A to ascertain what health facilities existed, what the staff situation was, and whether the statutory protocols, laid down by the Correctional Services Act and/or in legislation administered by the Department of Health, were being adhered to.

1.4 The delegation very deliberately decided that this should be an unannounced visit, so as to enable it to see for itself the situation as experienced by the average inmate. The point of departure of the delegation was that, while inmates should certainly not be able to claim better services than those available to the law-abiding community outside the prisons, inmates must be afforded the basic health care services guaranteed by the Constitution and the Correctional Services Act.

2. The Visit

2.1 The delegation consisted of Ms LS Chikunga, ANC MP, Mr S Mahote, ANC MP and Mr J Selfe, DA MP.

2.2 The visit took place on Wednesday 30 May 2007. In the course of the visit, the delegation interacted with Mr Smalberger (Regional Commissioner), Mr Mkabela (Area Commissioner: Pollsmoor Management Area), Mr Van der Westhuizen (Area Coordinator Corporate Services), Rev Fry (Acting Area Coordinator: Development and Care), Mr Ackermann (Assistant Director: Development and Care and Pharmacist), Dr Theron (District Surgeon), Mrs Dyamani (Head of Centre: Medium A), Mr Magagula (Head of Centre: Admission Centre), Mr Slinger (Head of Health Care Services), Mr Gertse (Sister) and Mr Ayslie (Nursing Assistant).

2.3 The delegation places on record its appreciation to these persons who made themselves available at extremely short notice, and provided information to the delegation.

3. Key Observations

3.1 The Client Base

3.2 Staffing

There is a severe shortage of professional and other medical professional staff. There are no doctors in the employ of the DCS at Pollsmoor, and the medical practitioners that do attend to patients are district surgeons. There is one part time doctor attached to the Admission Centre, and one part time doctor attached to Medium B.

As will be specified later, a number of the patients in the hospital section are mentally ill. The Head of Centre at Medium A said that a psychiatrist attends to these patients once a month.

There are 36 funded posts for nurses, of which only 14 are currently filled. The breakdown is as follows:

Funded Posts Filled

Admission Centre 12 4

Medium A 9 4

Medium B 5 3

Female 3 1

Medium C 7 2

Even this may provide an over-optimistic picture: the delegation was told when it visited the Admission Centre that one nurse had been suspended and one was on stress leave.

3.3 The supply and control over Drugs

Nurses practice their profession within the legal framework. The medicine and related substances Act, prescribes the storage of drugs and control of schedules 5,6 and 7 drugs in the Republic of South Africa. Adherence to the prescripts of this legislation is compulsory.

Findings:

Positive:

· Schedules 5,6 and 7 drugs are kept under lock and key.

· There are registers for the schedules 5,6 and 7 drugs.

Concerns and Challenges:

· Drugs that expired in November 2004 were still kept in the drug cabinet.

· Drugs that will expire in June 2007 were kept in the cupboard – intention as stated is to send them back to dispensary after expiry.

· Entries in the drug registers are very casual e.g. instead of recording the strength of the drug as prescribed e.g. 10ml for valium per 5mg to patient A and 5mg waisted – the entry just say 1 ampoute.

· The arrangement of drugs in the drug cupboard is horrible to say the least.

· Some drugs e.g. largatil injection 25mg could not the found in the drug register.

· Some drugs have not been entered in the drug register such that there was no balance between the drugs in the cupboard and those in the drug register.

Emergency Drugs:

· Most of these drugs had expired or about to expire. No proof of daily checking of the emergency drugs.

· Most drugs used for emergencies /resuscitation were not available.

Ordinary Drugs:

· Ordinary drugs that are suppose to be used daily e.g. TB Rifidi, had expired. What was of serious concern is that it was possible that these drugs could be given to patients.

Drug Storage:

· Both internal and external medicines are stored together.

· Medicine in the refrigerator was wet and eye drops were kept in the same container with other medication.

Recording of Drugs given:

· Drugs given to patients were not recorded.

3.4 The Emergency Trolleys

There are trolleys that are supposed to be used as emergency trolleys. There is very few emergency equipment and even that which is available, it is never checked and possible never be used. The following equipment could not be found:

a) Ambubag

b) Introducers

c) Endobracheal tubes etc

The oxygen cylinder – a cylinder with connections was available, but not properly working. There was no spare oxygen cylinder –waiting to be used.

Suction machines could not be found

Emergency equipment includes three things:

(i) Emergency Trolley

(ii) Oxygen with working oxygen apparatus

(iii) Suction medicine with working apparatus

These three apparatus should be kept together and checked daily and after each use. This is not happening and is not the case.

3.5 Other Equipment

Refrigerators

There are refrigerators used for medicine storage, but the temperature is not controlled.

4. Constitution and Correctional Services Act

Both the Constitution and the Correctional Services Act and its associated regulations provide for a basic level of health care. Section 27 of the Constitution provides that

“(1) Everyone has the right to have access to –

(a) Health care services, including reproductive health care;

(b) sufficient food and water; and

(c) social security , including, if they are unable to support themselves and their dependents, appropriate social assistance.

(2) The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

(3) No one may be refused emergency medical treatment.”

The Correctional Services Act (No 111 of 1998, as amended) provides very explicitly, in section 12, as follows:

“(1) The Department must provide within its available resources, adequate health care services, based on the principles of primary health care, in order to allow every prisoner to lead a healthy life.

(2)(a) Every prisoner has the right to adequate medical treatment but no prisoner is entitled to cosmetic medical treatment at state expense.”

Sub-sections (3) and (4) deal with the right of inmates to consult their own doctors at their own expense, and the consent that is required from inmates for medical procedures.

In addition, Section 6(5)(b) of the Act require that every inmate must, as soon as possible after admission:

“undergo a health status examination which must include testing for contagious and communicable diseases as defined in the Health Act, 1977 (Act 63 of 1977), if in the opinion of the medical officer it is necessary to protect or maintain the health of the prisoners or other persons.”

5. Patients Files

· Patients files do not reveal all medical and nursing intervention.

· Principles of record keeping are not observed on many of the cases.

6. The State of the Hospitals

Hospital environments should be conducive to healing. A clean environment provides a therapeutic environment. Hospitals are not different from the cells themselves. Besides lockers, beds, mattresses, bed linen and blankets, all can never promote healing at all. One blanket on a winter day can never promote recovery.

7. Findings and Recommendations

7.1 Staff Shortages

There is no doubt that the staff shortages, particularly of nurses, contribute to the situation outlined above. At the same time, even the most basic procedures and protocols appear in some instances not to have been followed. This indicates unethical conduct, lack of knowledge, lack of professionalism or perhaps all.

The Department told the delegation that they hope to fill the funded posts very shortly. The Department says that nurses are in short supply and heavy in demand, and that they, like many other institutions in South Africa, cannot compete for nurses because overseas institutions and private hospitals are able to offer better salaries and working conditions. The Department maintains that even the Department of Health offers more.

By way of illustration, 15 posts were advertised during the latter part of 2006. Only three people accepted appointment, and one left after only three days.

The Department argued that they would be able to attract staff if the salary scales were better. Currently, nurses are employed at Level 6, the maximum notch of which is R79 000 per annum. It was suggested that if the number of financed posts were reduced and the money was distributed to these fewer posts, there would be a better chance of attracting and retaining such staff.

Alternatively, the Department suggested that they be allowed to employ locums. A proposal in this regard was approved at the level of the Regional Office, but was disallowed by the Head Office.

The Regional Commissioner also stressed that shortages of medical staff were a feature that was unique to Pollsmoor. The only other Centre in the Western Cape in which this was a problem was Helderstroom, and that was because of the isolated location of that prison.

7.2 Management

It was clear that the medical staff were not appropriately managed. The Head of Development and Care at Pollsmoor is not medically trained. A nurse had previously occupied this post, but this person had been suspended pending disciplinary proceedings. The fact that protocols did not appear to be observed can, at least in part, be attributed to the absence of management.

However, the implication of short-staffedness is that the nurses cannot perform the essential task of screening the inmates before the visit of the district surgeon, with the result that they spend too much time attending to relatively minor ailments and not enough time on the serious cases.

7.3 Nurses Assistants and Staff Nurses

The department appears to employ nurses with particular qualifications. An ideal situation would be for staff nurses and nursing auxiliaries to be appointed (at lower salary levels) allowing the professional nurses to manage and oversee the proper and professional operation of the hospital sections.

7.4 Referral by /courts of accused for Psychiatric Observation

The courts frequently refer accused persons to Valkenberg Hospital for psychiatric observation. This process is essential for determining the culpability of the accused in terms of the Mental Health Act. Because the forensic wards of Valkenberg are themselves full to overflowing, many of the observation cases are taken up in the awaiting trial section of the hospital in Medium B. As has been reported above, these patients are usually visited by a psychiatrist once a month. The delegation was told that the Head of Centre is often subpoenaed to give evidence in Court on the mental health of inmates, despite not being qualified to do so and not directly involved in care and observation of such accused.

This is clearly unsatisfactory and required the intervention by the Department, the Department of Justice and the Provincial Administration of the Western Cape.

8. Conclusion

8.1 The delegation views the situation in these two hospital sections in a very serious light. There were acts and omissions which might have led to the deaths of inmates.

8.2 It is recommended that the entire Committee revisit these (and indeed other) hospital sections after a period to establish whether the matters highlighted in this report have been attended to.