REPORT OF THE PORTFOLIO
COMMITTEE ON CORRECTIONAL SERVICES ON HEALTH
BACKGROUND
1.1. The Portfolio Committee has received a number of comprehensive
briefings on health care facilities from the Department. The most recent took
place on
The prison-environment is one in which communicable diseases can spread easily.
Most correctional centres are overcrowded, some seriously so. In addition many
inmates are already ill and/or malnourished upon their admission.
1.2. In the course of 2006 and 2007, the Chairperson and Members of the
Committee received communication from a number of health professionals working
at Pollsmoor Correctional Centre. They complained of poor facilities, working
conditions and equipment in the hospital sections. 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.”,
and that
“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.”
Members encouraged the complainants to report their concerns to the relevant
levels of management, but agreed that the seriousness of the complaints also
warranted a Committee visit.
1.3 It was therefore decided that a delegation would visit the Pollsmoor
hospital sections at
the Admission and Medium A centres so as to ascertain the nature of the existing
health facilities, the working conditions for the staff, as well as 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 the visit would be
unannounced, so as to enable Members to view the situation from a perspective
that would be as near as possible to that of the average inmate. The delegation
was of the view that while inmates should certainly not be able to demand
better services than those available to law-abiding citizens, they had the
right to the basic health care services guaranteed by the Constitution and the
Correctional Services Act.
2. THE VISIT
The delegation comprised Ms LS Chikunga, ANC MP, Mr S Mahote, ANC MP and Mr J
Selfe, DA MP.
The visit took place on
The delegation places on record its appreciation to these persons who made
themselves available at extremely short notice, and readily provided the
delegation with the information it sought.
3. KEY OBSERVATIONS
Staffing
There is a severe shortage of professional and other medical professional
staff. Pollsmoor employs no doctors - the medical practitioners that attend to
patients are district surgeons. Two part-time doctors are attached to the
Admission, and Medium B centres respectively.
As will be elaborated on later, a number of the patients in the hospital section are mentally
ill and The Head of Centre at the Medium A section is of the
opinion that the large number of patients that are mentally ill, needed to be
attended to by a doctor at least once a month.
Of the 36 funded posts for nurses, only 14 have been filled:
|
|
Funded Posts |
Filled |
|
Admission Centre |
12 |
4 |
|
Medium A |
9 |
4 |
|
Medium B |
5 |
3 |
|
Female |
3 |
1 |
|
Medium C |
7 |
2 |
The
delegation felt that these figures might also be optimistic – during the visit
to the Admission centre the delegation was informed that a nurse had been
suspended, and that another was on “stress-related sick leave”.
The supply and control over Drugs
Nurses practice their profession within the legal framework provided by the Medicine
and Related Substances Act which prescribes the storage of all drugs, and the
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 had expired as far back as November 2004
had not been disposed and were still kept in the drug cabinet while drugs that
will expire in June 2007 were kept in the cupboard with the intention of
sending them back to dispensary once they had expired.
·
The entries made into the drug registers are very
casual - instead of recording the strength of the prescribed drug e.g. 10ml for
valium per 5mg to patient A and 5mg wasted, the entry merely reads 1 ampoule.
·
The arrangement of the drugs was horrific and left
much to be desired.
·
Some drugs (e.g. largatil injection 25mg) could not
the found in the drug register.
·
Some drugs had not been entered into the drug
register and thus the drugs in the register did not correspond to what was in
the cupboards.
Emergency Drugs:
·
Most of the drugs had expired or were about to
expire and there was no evidence suggesting that emergency drugs were being
checked on a daily basis.
·
Most of the drugs used for emergencies or
resuscitation were not available.
Ordinary Drugs:
·
Ordinary drugs that are supposed to be used on a
daily basis e.g. TB Rifidi, had expired. The delegation was particularly concerned
that these drugs could accidentally be administered tom patients.
Drug Storage:
·
Internal and external medicines are stored
together.
·
The medicine in the refrigerator was wet and eye
drops and other medication were kept in the same container.
Recording of administered
drugs:
Drugs
given to patients were not recorded.
The Emergency Trolleys
There is very little emergency equipment and the equipment that is
available is never checked and possibly never used. The following equipment
could not be found:
(a) Ambubag
(b) Introducers
(c) Endobracheal tubes etc
An oxygen cylinder with connections was available, but was faulty. There was
also no spare oxygen cylinder and suction machines could not be found.
Emergency equipment was lacking and was not being checked regularly. The
following emergency equipment should be kept together and checked daily and
each time that it has been used:
(i) Emergency Trolley
(ii) Oxygen with working oxygen apparatus
(iii) Suction medicine with working apparatus
3.5. Other Equipment
Refrigerators
While there were refrigerators to be sued for storage, the temperature
within these fridges was not controlled.
4. THE CONSTITUTION AND THE 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.”
Section 12 of the Correctional Services Act (No 111 of 1998, as amended) reads
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) provide inmates with the right to consult their own
doctors at their own expense, and that consent must be sought should inmates
require medical procedures.
In addition, Section 6(5)(b) of the Act requires 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.”
PATIENT- FILES
·
Patient-files do not reveal all medical and nursing
interventions.
·
In many cases the principles of good and effective
record-keeping are not being observed.
THE STATE OF THE HOSPITALS
The
hospital environment should be conducive to healing. It should be clean,
hygienic and therapeutic. The delegation found that at Pollsmoor hospital
sections were no different from the cells themselves. While basic provisions
such as lockers, beds, mattresses, bed linen and blankets are not enough to
guarantee recovery, their absence severely hampers recovery and the restoration
of health.
7. FINDINGS
7.1. Staff Shortages
There is no doubt that staff shortages, particularly the shortage of
nurses, contribute to the unsatisfactory situation outlined above. The fact
that in some cases even the most basic procedures and protocols appear to not
be observed, is an indication of unethical conduct, lack of knowledge and lack
of professionalism.
The Department informed the delegation of its intention to fill the funded
posts very shortly. It reported that nurses are in short supply and in heavy
demand. The DCS, like many other institutions in
The Department argued that it would be able to attract staff if the salary
scales were improved. Currently, nurses are employed at Level 6, and earn at
the maximum salary notch i.e. R79 000 per annum. It was suggested that should
the number of financed posts be reduced and salary savings were distributed
among the reduced positions, there would be a better chance of attracting and
retaining the necessary nursing staff. Alternatively, the Department suggested
that it be allowed to employ locums. Regional office had approved such a
proposal, but it was disallowed by the Head Office.
The Regional Commissioner stressed that the shortage of medical staff was a
feature unique to Pollsmoor. The only other centre that experienced the same
challenge was Helderstroom whose isolation contributed to the shortage.
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 is on suspension 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.
The staff shortage resulted in nurses not being able to perform the necessary
screening of inmates prior the visit by the district surgeon. They also 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. Ideally
staff nurses and nursing auxiliaries should be appointed (at lower salary
levels) thus allowing 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 Court frequently refer accused persons to Valkenberg Hospital for
psychiatric observation. This process is essential in determining the
culpability of the accused in terms of the Mental Health Act. Because the
forensic wards of Valkenberg are themselves full or overflowing, many of the
observation cases are taken up in the awaiting trial section of the Medium B
hospital section. As has been reported above, these patients ought to be
visited by a psychiatrist once a month. The delegation was told that despite
not being qualified to do so and not being directly involved in the care and
observation of such accused, the Head of Centre is often subpoenaed to give
evidence on the mental health of inmates. This is clearly unsatisfactory and
requires l intervention by the DCS, the Department of Justice as well as the
Provincial Administration of the
8. CONCLUSION
The delegation views the situation in these two hospital sections in a
very serious light, especially considering there had been acts of negligence
and lack of adherence to the relevant legislation and regulations that might
have led to the deaths of inmates.
The Committee will, after a certain period re-visit these and other hospital
sections so as to establish whether the matters highlighted in this report have
been attended to.