REPORT OF THE PORTFOLIO
COMMITTEE ON CORRECTIONAL SERVICES ON HEALTH
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.”,
“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
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:
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.
· 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.
· 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 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.
· 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 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:
(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
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 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.
7.1. 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.
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
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.