Victoria’s prison healthcare system should match community healthcare

Aboriginal and/or Torres Strait Islander readers are advised that names of deceased people are included in this article.

The Victorian Aboriginal Legal Service is representing family members of Veronica Nelson, Ms Calgaret, and Michael Suckling in coronial investigations/inquests into their deaths in custody.

When someone is placed in prison, they are entirely dependent on prison officers and prison health-care providers. Incarcerated people do not get to choose when they see a doctor or mental health practitioner, when they take medicine, or what type of care they receive. They cannot call 000 and be taken to a hospital if they are dangerously ill.

In Victoria, if a person in prison is Aboriginal and/or Torres Strait Islander, they do not get access to culturally competent care through Aboriginal community-controlled health organisations. In Victoria, prison health care is provided by for-profit private companies contracted by the state government.

Imprisoned peoples’ physical health and/or social and emotional well-being is at the mercy of prison officers and prison healthcare providers.

Through our practice at the Victorian Aboriginal Legal Service, we have seen the differences between how people are treated in the community and how they are treated in prisons and youth prisons.

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The right to healthcare continues when people are incarcerated

International law requires “prisoners should enjoy the same standards of health care that are available in the community”. This healthcare should be “free of charge” and “without discrimination”. It also makes clear everyone has the right to the “highest attainable standard of physical and mental health”.

The Victorian Charter of Human Rights and Responsibilities requires that persons deprived of liberty (such as people in prison or police custody) be treated with humanity and respect.

The Coronial Inquest into the death of Yorta Yorta woman, Aunty Tanya Day, found that police and prison staff must ensure access to medical care for detained people. Under law, incarcerated people in Victoria have the “right to have access to reasonable medical care and treatment necessary for the preservation of health”.

Yet incarcerated people in Australia are excluded from access to funding under Medicare and the Pharmaceutical Benefits Scheme. This impacts not only health care in prisons by Aboriginal health services, but also the ability to provide continuity of care to incarcerated Aboriginal people as they enter and exit prison.

In Victoria, health care in prisons is the responsibility of the Department of Justice and Community Safety, not the Department of Health. Health care is provided by a subcontracted and fragmented system of multiple, private health-care providers. This contributes to inconsistent health care across the prison system.

From our clients in prison, we hear about limited access to health care for critical conditions such as cancer, diabetes and heart problems. What’s more, people in prison are often prescribed medication without a thorough health check. Self-harm incidents among Aboriginal people in Victorian prisons have risen by more than 50%. Despite this, we still hear of lack of access to counselling, psychiatric care, trauma and grief support.

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Imprisonment should not be a death sentence

There have been more than 500 Aboriginal and/or Torres Strait Islander deaths in custody since 1991. Last year, a Guardian analysis on the 30th anniversary of the report of the Royal Commission into Aboriginal Deaths in Custody found:

For both Aboriginal and Torres Strait Islander people and non-Indigenous people, the most common cause of death was medical problems, followed by self-harm.

However, the Guardian also found Indigenous people who died in custody were three times more likely not to receive all necessary medical care, compared with non-Indigenous people. For Indigenous women, the result was even worse – fewer than half received all required medical care prior to death.

This conclusion is chilling, given that incarcerated people, particularly Aboriginal people, have higher rates of underlying health conditions than the general population.

The Royal Commission into Aboriginal Deaths in Custody recommended prison health care be culturally safe and “be of an equivalent standard to that available to the general public”. This recommendation still has not been implemented.

Multiple upcoming coronial inquests will examine deaths in custody in Victoria’s prisons, and the adequacy of prison healthcare. Aboriginal man, Michael Suckling, died of a suspected stroke at Ravenhall Correctional Centre. His death will be examined in a coronial inquest later this year.

Veronica Nelson, a proud Gunditjmara, Dja Dja Wurrung, Wiradjuri and Yorta Yorta woman, died at Victoria’s main women’s prison, Dame Phyllis Frost Centre. A coronial inquest into her death began last week. The inquest will examine matters including the adequacy of the healthcare Veronica was provided in prison, and whether her Aboriginality affected the treatment she received.

Ms Calgaret, a proud Yamatji, Noongar, Wongi and Pitjantjatjara woman, died at Sunshine Hospital after being transferred from Dame Phyllis Frost Centre in a critical condition in November 2021. The death of a newborn baby at the same prison is also being examined in an upcoming coronial inquest. Despite these deaths and widespread calls for the Victorian Government to invest in community not prisons, the government is proposing to expand Dame Phyllis Frost Centre.

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Culturally safe healthcare for Aboriginal people

The Australian Health Practitioner Regulation Authority has defined cultural safety as follows:

Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practise is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.

The first Aboriginal community controlled health organisation was founded in Redfern in 1971, “in response to experiences of racism in mainstream health services and an unmet need for culturally safe and accessible primary health care.” Aboriginal-led health organisations are essential to ensuring culturally safe health services are provided to Aboriginal people, and are a manifestation of Aboriginal self-determination.

In the Northern Territory and the ACT, Aboriginal community controlled health organisations have begun coming in to prisons to deliver primary health services in adult and youth prisons.

This is a crucial first step to providing culturally safe healthcare to incarcerated Aboriginal people. This will improve access to healthcare for those who are imprisoned, and provide support and consistency upon release. This is vital when many of our community members cycle in and out of prison at frequent intervals, due to failures of the justice system.

Time to action the lessons learned

In prisons, officers and prison health staff make life and death decisions every day. When they are negligent, there must be accountability, space for truth, and justice.

The Victorian and Federal governments do not need any more “examples” of what can happen when healthcare is not equivalent to that in the community, and is not culturally safe. Aboriginal people are dying in custody, becoming disabled, or living with the preventable development or exacerbation of mental or physical health conditions as a result of negligent practices.

The writing is on the prison wall.

It is time for governments to care, it is time for them to act.

This article was written with permission from Apryl Day to write about Aunty Tanya Day, and the family members, whom VALS represents, of Veronica Nelson, Ms Calgaret, and Michael Suckling.