The State’s prison watchdog has criticised the failure of prison staff to arrange the urgent transfer of a terminally ill prisoner to hospital as directed by a prison doctor.
The Inspector of Prisons, Patricia Gilhealy, said it represented “a major failing” by the prison authorities at the Midlands Prison in Portlaoise.
Ms Gilhealy has called on the Irish Prison Service (IPS) to ensure all “urgent” hospital referrals in future are prioritised.
Although the IPS provided evidence that standard operating procedures for prisoners needing urgent medical attention were being implemented, the inspector said it was concerning that they still allowed hospital referrals to be cancelled for operational reasons such as no escort staff being available.
A report into the death of the 53-year-old prisoner revealed that 54 medical appointments for prisoners in the Midlands Prison had been cancelled in the previous year due to staff shortages.
The man, who had been in custody since 1985, died in St James Hospital in Dublin on June 14, 2018.
He had been diagnosed with a terminal condition in late 2017 and was transferred to the Midlands Prison from Shelton Abbey in order to have improved access to medical care.
The prisoner had been referred to the Midlands Regional Hospital in Portlaoise after he had complained of severe pain two days earlier.
The prison doctor had recorded the referral as “urgent.” The prison authorities were notified via e-mail by a nurse at 10.52am on June 12, 2018 that the man needed to be transferred “as soon as possible”.
However, the report said the nurse contacted the prison authorities again at 5.30pm after she became aware the prisoner had not been taken to hospital some seven hours after he had been examined by the doctor.
She was informed that there was not enough prison staff to escort him to hospital.
Without consulting the doctor, the nurse agreed that the referral could be deferred until the following morning as she considered that the prisoner was not in distress.
The report said such a view was at odds with the man’s two carers who said he was “not in good shape” at the time and that his pain was “extremely bad”.
It said the prisoner was not brought to the hospital “first thing” the next morning but only after he was found in a collapsed state in his cell after he sounded an alarm bell at 10.33am.
He was brought to the Midlands Regional Hospital in Portlaoise by ambulance and transferred later that day to St James’ Hospital in Dublin.
Ms Gilhealy said several concerns arose over the failure to follow the doctor’s instruction including the fact that nobody seemed to treat his transfer to hospital with any degree of urgency even after it was deferred.
The inspector said the contact details for the prisoner’s next-of-kin were incorrect which delayed notification to his family at a critical time and they were only alerted to his condition shortly before he passed away.
Ms Gilhealy said a delay of over seven hours by prison staff in responding to the request by hospital staff to notify the man’s relative was “poor practice” whether due to miscommunication or tardiness.
She also noted that several prison staff involved in the prisoner’s care did not attend a critical case review into his death.
Ms Gilhealy remarked that one prison officer had made “an unbecoming attempt” to absolve the prison’s detail office, which oversees the transfer of prisoners, from any blame.
The inspector said the IPS should satisfy itself about the competence of all staff involved in the failure to follow the doctor’s orders and “take any action necessary to ensure there is no repeat in any prison establishment”.
She also said an increased number of medical checks should be immediately carried out on any prisoner who had an urgent hospital referral delayed.
The IPS fully accepted 10 out of 11 recommendations made by the watchdog including the need for staff to fully detail all their records and evidence in relation to deaths in custody.
It said a reminder had been issued to all prison staff of the importance of urgent hospital referrals for prisoners, while an e-mail group was being established in all prisons to ensure relevant staff were aware of proposed transfers and their timeframes.
The IPS only partially accepted the inspector’s recommendation for a review of the application of its Compassionate Temporary Release Policy to ensure that terminally ill prisoners were released on licence in order to avoid the indignity of dying in prison.
It said such decisions were made on a case by case basis but decision makers should not be required to give medical options more significance over other factors such as security issues.
The report noted how the prisoner’s family had felt aggrieved that they had to arrange and pay for his funeral, even though his daughter was only an infant when he was sent to prison.
It said there seemed to be a breakdown in communication that the man’s daughter was unaware that the IPS had contributed €2,000 towards the cost of the funeral – the maximum sum permitted – while the prison governor had also authorised a further €100 towards the cost of clothing for his remains.