Leigh Day & Co have commenced a
judicial review challenge against the Secretary of State for Justice and the Isle of Wight Primary Care Trust (PCT) on behalf of a serving prisoner, Mr B, in relation to their repeated failure to provide him with adequate treatment and care for his serious foot injuries.
Mr B was initially imprisoned at HMP Bullingdon, in Oxfordshire, in April 2006. Prior to his imprisonment in March 2005, Mr B had sustained bi-lateral calcaneus factures to both his feet, which required total reconstructive surgery. This surgery involved the insertion of metal plates and numerous pins into each of his feet. Since this time, however, Mr B has suffered, and has continued to suffer, severe pain and discomfort in his left foot.
After almost 6 months of imprisonment, Mr B finally attended a hospital appointment with his treating Orthopaedic Consultant, who confirmed that, on account of his continuing pain, he required surgery for the removal of the metal plate from his left foot. To date, however, Mr B is still waiting, some 20 months later, to undergo this very necessary surgery.
The judicial review challenge identifies two main causes for the unacceptable delay in providing Mr B with the treatment he requires.
Continuity of healthcare within the prison system
Since Mr B was originally assessed as requiring this surgery whilst an inmate at HMP Bullingdon, he has been transferred to two further prisons, including HMP Parkhurst on the Isle of Wight and HMP Coldingley in Woking (where he now remains).
On each occasion that Mr B has been transferred to another prison, he has to start the referral process afresh. This process involves, a Prison Doctor making a fresh referral to an Orthopaedic Consultant at a new hospital, Mr B attending an appointment at that hospital, and then the Orthopaedic Consultant assessing Mr B as requiring a referral for the surgery. Whilst Mr B was an inmate at both HMP Bullingdon and HMP Parkhurst, this process had taken over a year to complete, without ever reaching the point where he had actually undergone the surgery required.
Furthermore, on each occasion that Mr B has been transferred, neither the transferring nor the receiving prisons seem to have taken any steps to expedite this referral process.
Now at HMP Coldingley, Mr B yet again appears to be starting this referral process afresh. Given his previous experiences of the prison referral process, Mr B is concerned that he will inevitably have to face a further lengthy wait before the process reaches the point that he will undergo surgery. Until this time, Mr B remains in considerable pain and discomfort.
It is argued that the Defendants are failing to provide Mr B with any continuity of healthcare whilst in prison for the injuries to his feet. This has caused him unacceptable delay in receiving the treatment he requires.
We consider that this not only contrary to the guidance set out in Prison Service Order (PSO) 3050, “Continuity of Healthcare for Prisoners”, which emphasises the importance of continuity in the success of clinical treatments, but demonstrates a wholesale disregard for the purported commitment to providing prisoners equivalence of healthcare to that of the wider community.
Prison escorts for hospital appointments
Although the failure to provide any continuity of healthcare has caused inevitable delays in Mr B receiving the treatment he requires, another cause for the inordinate delay appears to be the repeated cancellation of his hospital appointments.
Whilst an inmate at HMP Parkhurst, Mr B had a number of hospital appointments cancelled. Despite the Hospital only being less than 1 mile in distance from the Prison, these appointments were cancelled because no prison escorts were available.
This lack of availability appears to be the result of the Defendants’ failure to follow their own policies with regard to the cancellation of hospital appointments, as well as the result of an overall lack of prison escorts.
The Defendants own policies state that cancellations should be avoided and that if appointments are cancelled due to a lack of prison escorts this should only be done after prior consultation with a Prison Doctor. This policy has not been followed in Mr B’s case, with a prison nurse making the decision to cancel or refuse any appointments offered by the Hospital.
More fundamentally, however, it is argued that this demonstrates a systemic flaw in the prison healthcare system. Prisoners should not be put into competition for hospital appointments as a result of an overall lack of prison escorts. In such a healthcare system a bottleneck will occur in which more urgent cases of prisoners requiring treatment will continually ‘trump’ cases such as Mr B, which means he faces repeated cancellations and further delay.
PSO 3050 identifies a number of audits and reviews to be carried out by the Defendants to monitor the number of cancellations of prisoner hospital appointments. From our investigations, it is far from clear whether these audits / reviews have been carried out. However, from the experiences of Mr B, it appears that an overall lack of available prison escorts is resulting in a number of cancelled hospital appointments, which is neither being identified nor addressed by the Defendants.
It is argued that this irrational system of providing healthcare to prisoners is undermining the principle of equivalence of healthcare. Furthermore, given that a prisoner requiring medical treatment is placed in a particularly vulnerable position, as they are unaware of any cancellations, and cannot determine when and where they attend their hospital appointments, it is argued that to protect a prisoner’s right to an equivalent standard of healthcare it is of the utmost importance that a policy is implemented, and then followed, to allow them to promptly attend the hospital appointments offered.
Equivalent standard of healthcare for prisoners
In 2004, the Prison Service committed themselves to providing a universal standard of healthcare for all prisoners. This standard was established by Prison Standard 22, “Health Services for Prisoners”, which committed the Prison Service to providing “prisoners with access to the same range and quality of services as the general public receives from the National Health Service (NHS)”.
Over 4 years since this standard was introduced, the problems experienced by Mr B, demonstrate that there is a palpable failure by the Prison Service, and now by the individual Primary Care Trust’s (PCT’s) commissioned to provide healthcare services within Prisons, to attain this standard of healthcare for all prisoners.
The factual background to Mr B’s case shows the Defendants failures to adhere to this standard in a particularly stark light.
It is also argued that this delay in providing Mr B with adequate treatment and care, and failure to provide him with a standard of healthcare equivalent to that provided to the wider community, is also in breach of Articles 3 (right to life), 8 (right to private and family life) and 14 (prohibition on discrimination) of European Convention of Human Rights (ECHR).
Leigh Day and Co instructed Shaheen Rahman, a barrister at
1 Crown Office Row specialising in prison healthcare issues, in relation to this matter.
JUSTICE, the independent legal human rights organisation, have indicated that, if Mr B's case proceeds to a full trial, they will seek to intervene as consider that the cases raises issues of public importance concerning the provision of basic healthcare to prisoners.
For more information please contact
Sean Humber or
Benjamin Burrows on 020 7650 1200.
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