Who do prison doctors serve?

A number of cases are emerging from Correctional Service regulation of the non-narcotic pain-killing drug, Gabapentin. These cases highlight the lengths to which CSC will go to promote their view of institutional security, even at the expense of fair access to essential health serve – even at the expense of continuous pain for some prisoners.

Gabapentin has been highly successful in treating all sorts of pain conditions and until recently was frequently prescribed to prisoners. Then in 2015 CSC concluded that the drug was being overused for trafficking purposes.

CSC sent out an announcement to prisoners indicating that no new prescriptions for Gabapentin would be issued after August 1, 2015 except for patients suffering from epilepsy or from neural pain caused by diabetes or shingles. CSC offered the opinion that ” there is no proof that [Gabapentin] works for other types of pain”.

This left the prisoners who had already been on Gabapentin prior to August 1, 2015. Here CSC established a “grandfathering” regime. Prisoners on Gabapentin  prescriptions, other than for epilepsy and pain from diabetes or shingles, would be permitted to continue on the drug only if, via the institutional physician, a formal request was made to Regional authorities who manage the CSC formulary and the request was accepted.

Requests for continuation of use of Gabapentin were to be made by March 1, 2016 failing which the prisoners in question would be deprived of Gabapentin as of April 1, 2016. Physicians were to assist in finding alternative medications that would meet the needs of prisoners.

The Current Situation (May, 2016)

I am aware of a  number of prisoners who suffer from severe, chronic pain who have seen their  (previously successful) Gabapentin prescription ended as of April 1, 2016.

In some cases the institutional physician has refused to seek continued access to the drug. In others, the formulary authorities have refused to permit continued treatment.

Where physicians have refused to request continued treatment, this has been either because the physician purported to believe that Gabapentin was unnecessary or because the physician expressed the view that a formulary request would simply not be granted.

In almost all cases I have seen, the prisoner in question had been enjoying successful treatment with Gabapentin, sometimes in combination with another drug, for many months or even years.  There are opinions on their files from pain specialists/ neurologists to the effect that Gabapentin has been, and remains, an effective response to the pain in question.

Now these prisoners are suffering pain, as could be anticipated, occasionally with some assistance from narcotic prescriptions that, at first blush, seem far more’ dangerous” than non-narcotic Gabapentin, from a security perspective. They have sought second opinions and made repeated requests for Gabapentin relief but, to date, they continue to be in pain.

Options

One would think that prisoners could seek judicial review in Federal Court to attack decisions removing Gabapentin. A problem with this approach is that it can involve long delays should the Court determine that complaints should go through the grievance procedure ( “an adequate internal remedy” that the Court has usually supported). As well, the Court could be convinced that the decisions under review were those of medical doctors and not government officials, thus removing them from judicial review jurisdiction under the Federal Court Act.

While civil actions might be effective, and would by-pass the above-mentioned obstacles, the process for Actions in both Superior Courts and the Federal Court is painfully slow, and is not usually accepted for legal aid support.

My view is that there are ways of dealing with these problems, which I will not be disclosing in this article for obvious reasons. ( I don’t think the Department of Justice pays much attention to my blogs but who knows?)

The policy issue – here we go again

The important point here is that CSC  is once again adopting a lock-step approach to an important prisoner right wherein perceived notions of security trump essential health care.

I don’t say that there was a deliberate agenda behind the way the policy on Gabapentin was rolled out but it is clear that a principal aspect is to somehow protect CSC against judicial review.

Moreover, the decision is being implemented in an atmosphere where CSC physicians are under considerable pressure to tow the line even if, absent the new rules, they would have continued the prescription. Herein, expert second opinions can be either prohibited or ignored.

As well, the policy is based on comfortable generalities, purported research conclusions, that support prohibitions of rights.

Compare this, for example, to CSC policies on access to digital tools and in-cell computers.

CSC decided, despite considerable adverse opinion, that any form of even potential digital communication with the community was too much of a security issue ( especially a drug interdiction issue) to permit any form of communication. Cell computers were grandfathered and to this day prisoners are having to take legal measures to prevent their ancient computers from being taken away.

Meanwhile numerous jurisdictions around the world are accepting the reality of computers and email/internet communications as akin to a basic human right.

Nobody disputes that security concerns exist. The problem is that fundamental rights may be sacrificed by the template of CSC security – security is the central issue and policy must be adapted to this priority by allowing overriding prohibition of rights enjoyed in the community and by setting up breastworks to fend off legal  challenge.

This really hurts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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