Now I may be somewhat biased, but it seems to me that the recent review of medical services in Public Prisons has done nothing to lighten the load of our overworked and underpaid nursing staff. The reality is that everywhere I go these days, I am approached by dedicated but somewhat stressed medical employees with concerns about under-resourcing, understaffing and overworking.

In fact, medical resources are stretched to such an extent that more and more work that is traditionally carried out by qualified nursing staff is being delegated to duty Corrections Officers. The result of this is that COs are being asked to administer “over the counter” medication and prescription medication, and assess whether inmates are fit enough to participate in sporting activities. Now I could bore you with a regurgitation of the “layman’s guide” to the problems associated with the administration of medication, but it’s probably far more appropriate to reproduce a medical professional’s opinion for your consideration. That opinion is as follows:

An inmate does not have the purchasing power to obtain OTC drugs for him or herself – therefore if you are giving the drug to them you are dispensing it. According to law if you are dispensing a drug you are accountable for the consequences of the action the drug takes and purpose for which it is given.

In the prison environment you will have observed nurses giving OTC drugs (mainly paracetamol.) There are many more but for the purpose of expediency I will focus on this drug.

Paracetamol is not given on an ad hoc basis or for placebo effect. If the nurse gives paracetamol to an inmate without asking questions it will be because she/he knows the inmates medical history in relation to liver function or drug reactions.

If an inmate asks for paracetamol for a headache for example, the nurse will ask questions and while doing so will be visually accessing the inmate for signs that may indicate something more sinister is happening physically than just a headache. A headache may mean a lot of different things can be happening to the inmate. It includes, but is not limited to;

Onset of meningitis
Subdural haemorrhage
Raised intracranial pressure
Onset of illness
Onset of septicaemia
Dehydration
Hypoglycaemia

These are only a few examples of what a headache may indicate.

Nurses are comprehensively trained to observe the inmate/patient for signs that indicate more is going on for the person at that time. It may not appear that the nurse is observing the inmate/patient for anything, it may appear she/he is asking unnecessary questions thus wasting time – however she/he will be accessing the inmate/patient for signs of the following:-

Sweating
Guarding of parts of the body
Gait – signs of unsteady walking
Sitting – straight or slightly leaning to one side
Listening to symptoms and linking them to signs of insidious manifestations.

If a medical condition is present – like diabetes, a blood sugar level will be done to ensure the headache is not associated with a hypo (hypoglycaemia) meaning low blood sugar level. If this is present, this is a life threatening condition and requires urgent treatment. The level of intensity of treatment will be determined by the blood sugar reading.

If raised inter-cranial pressure is suspected e.g. the inmate/patient may have been hit on the head as long ago as three days (it can take that long for a seeping blood vessel to expel enough blood to cause the pressure in the brain to raise.) O if meningitis is suspected the nurse will investigate by accessing the pupil size and its reaction to light. She/he will also assess blood pressure, pulse and orientation to time place and person. She/he will assess for vomiting or nausea all of which are signs of raised inter-cranial pressure. Raised inter-cranial pressure is fatal if not diagnosed and treated surgically within a very short time frame.

A headache is one of the first signs of many medical conditions or it may simply as is mainly the case just a headache that a couple of Panadol will fix. Whatever the case, remember that you as the dispenser of the drug are accountable for the outcome.

I know that many members have been concerned about this issue for some time and, having read the above, I’m sure that many more of you will share those concerns. However, if that’s not enough to get your sphincter twitching, then consider the following extract of a recent email from another very concerned staff member:

All the staff in our unit are concerned about the high numbers of Panadol and Solprin being issued on demand by inmates with no explanation needed or any proof of illness. We currently have a major problem in trying to get inmates to see a doctor, the last lot were held in 4 days in a row until I threatened to drop an inmate with his gear in the health unit. Therefore Panadol etc. is given out in lieu of treatment.

I would point out to you that last week I uncovered a scam whereupon inmates were diverting the medicine Tramadol which was given out in blister packs for up to 2 pills a day for 7 days. I learnt that if an inmate abstained from taking them for up to 3-4 days then swallowed a handful. The inmate was off his face in no time.There were a number of incidents that would back up our suspicions and we just happened to have an inmate under the influence that confirmed this. It is no use getting them urine tested as we were dispensing the drug. However this drug is now issued under the same protocol as methadone. We do however hold strong fears that Panadol, Solprin etc. are being used to be cut with this stuff to increase quantity.

We have tried to discuss the above matter with PPS representatives in a rational and professional manner, but we have been repeatedly put off and, in our opinion, misled on this issue and it’s time to call a halt. Accordingly, I have been instructed to file a Dispute and Application for Compliance with the Employment Relations Authority with urgency and this will be done without delay.

Another issue that will be dealt with under the same application will be the recent requirement for Corrections Officers to assess the suitability of inmates in their Unit for participation in sporting activities. Once again;

1. It’s not your job,
2. Your not qualified to carry out such assessments,
3. You run the risk of being subjected to an investigation in the event that an inmate complains to the Ombudsman – or one of the many other avenues they have at their disposal – about your decision and associated recommendation!

Remember that you have the right, pursuant to the provisions of the Health and Safety in Employment Amendment Act 2002, to refuse work that is likely to cause serious harm. Accordingly, if you believe that the administration of medication by Corrections Officers falls into this category, then document the fact and forward it to your Unit Manager and CANZ representative!

It is important that you document specifics in respect of the issue at hand (Unit, affected inmates, amount of medication etc.) and refer to this update in support of your concerns. If your manager rejects your concerns and gives you what is deemed to be a lawful instruction, then;

I. Comply with the instruction under protest, and
II. Immediately contact your CANZ representative.

We do expect this update to generate some sort of reaction from your employer and we will keep you updated of progress.

Regards,

Brian Davies
National Organiser