- Email: [email protected]
Prison Medical Service
789
An editorial on p 755 looks at some questions that have been voiced lately about the medical and nursing care of persons held in prison in Britain. The following outline of the services as they exist is offered as a factual supplement to the editorial
the provision of reports to courts (over 9000 were supplied last year); the organisation and provision of general medical services (over 1 million professional contacts last year); and referrals to specialist services (100 000 last year). Their other tasks include preventive medicine and environmental health, occupational health, and advice to management on such matters as nutrition and sanitation. In the past 2 years, the recruiting position has improved from 27% of posts vacant to only 3%. During this time, some 90% of appli-
THE Prison Medical Service in Britain derives from the work of John Howard, the prison reformer of the late 18th century; and it was set up, largely in its present form, in 1877. Its medical officers are Civil Servants and it is administered by the Prisons Department of the Home Office. It thus predates the National Health Service and was left untouched when the NHS began in 1948. Just over 100 full-time medical officers cover the four regions of the countrynorth, midlands, south-west, and south-east. There are also about 100 part-time medical officers and some locums. Many NHS specialists of all disciplines provide support by prison visits and by receiving prisoners as outpatients or inpatients. The great majority of part-timers and locums are NHS general practitioners who practise near prisons. Thus, most of the clinical work in prisons is performed by doctors whose main professional employer is the NHS. The full-time medical officers are either those with postgraduate specialty qualifications and experience in psychiatry, particularly forensic psychiatry, or those experienced GPs who have joined the Service, often in mid-career. Of the 26 medical officers recruited in the past two years, 14 had postgraduate specialist qualifications (11were members of the Royal College of Psychiatrists), 7 were principals in general practice, 2 had long experience in treating drug addiction, and 3 had passed part 1 of the MRCPsych examination and wished to complete their qualification. The role of full-time medical officers con-
A vital part of the Prison Medical Service is the work of the hospital officer and nursing staff. The hospital officers, providing nursing care for male prisoners, number about 1000, and the total will rise as new establishments open. 2 years ago, 68 of the 840 hospital officers in post held a nursing qualification: at present 110 of almost 1000 are so qualified. At the moment planning aims at raising the proportion of the nurse-qualified to 360 out of 1200 in the next 3 years. Hospital officers receive 24 weeks’ basic training, followed by continuing instruction after appointment to a post. There are many similarities in needs and organisation to training requirements in comparable parts of the medical structure of the Armed Forces. The 200 nursing officers, who (unlike hospital officers) are not trained in security measures, are qualified as nurses and provide nursing cover for women in prison (about 1600, or 3% of the prison population). Members of the nursing service do not wear prison service uniform. While carrying out their duties, they often require escort by discipline officers, in circumstances which vary from establishment to establishment. Completing the Prison Medical Service, 16 pharmacists work in the major prison establishments and supervise pharmaceutical supplies to their own prisons and to neighbouring satellite prisons. Each dose of medication is given to the patient or inmate separately so that its administration can be effectively supervised.
cerns :
Prison Medical Service
Medicine and the Law When Can a Patient Sue for Negligence and Wrongful Detention under the Mental Health Act? IN order to protect doctors from the real or imaginary threat of a flood of actions by aggrieved persons treated under the Mental Health Acts, the law requires that a mental patient must obtain the leave of a High Court judge before he or she can bring an action to sue a doctor and/or a health authority for alleged negligence and wrongful detention, &c. Under section 141 of the 1959 Act, doctors and health authorities were so protected that such a patient bent on suing had a much more difficult task to obtain the leave of the court than did a vexatious litigant. Section 141 required the patient to demonstrate a very substantial prima-facie case before the court could grant leave to proceed with the action. The intention was, no doubt, to deter disgruntled mental patients with imaginary claims from suing their doctors for alleged ill-treatment or negligent false
imprisonment in hospital. Routley v Vaudrey and others! illustrated clearly how onerous the requirements were before a person could sue under the Act. The position has been vastly changed, however, by s 139 of the 1983 Act (which replaces s 141): the patient is now no longer required to make out a substantial prima-facie case. The correct test today, as lately propounded by the Court of Appeal in Winch v
Jones and others &c,2 is whether, on the material before the court, the patient’s complaint appears to merit fuller investigation. In Winch v Jones, the Court of Appeal has allowed two appeals from Mr Justice Otton’s refusal to give a patient leave. In a leading judgment, Sir John Donaldson, Master of the Rolls, said that the applicant had claimed that the respondent doctors had been 1. Brahams D.Proceedings for false imprisonment and negligence under 1959 Mental Health Act.Lancet 1983; ii: 466. 2 SeeWells W.Negligence and the Mental Health Act.Lancet 1985; ii: 547.
cants were
unsuccessful.
negligent when they recommended her admission to and continued detention in the North Wales Hospital, Clwyd, under s 26 of the 1959 Act. Although the patient had been detained under the 1959 Act, it had since been repealed and s 141 had been replaced by s 139 of the 1983 Act and (by para 28 of Schedule 5 of the 1983 Act), it was s 139 which now applied to her claim. Section 139(2) merely provided that "no civil proceedings shall be brought without the leave of the High Court ..." The removal of the previous words which required the court to be satisfied of "substantial ground for the contention that the person to be proceeded against has acted... without reasonable care" amounted to a considerable change of approach by the court. Mr Justice Otton had concluded that the applications were not frivolous or vexatious nor were they an abuse of the process of the court. He concluded, however, that he should not grant leave, because a prima-facie case of negligence had not been established against each of the two doctors sued. For the patient it was argued that the test should be whether there was "a serious issue to be tried". The Master of the Rolls said that’s139 required an individual approach. Claimants who had to show a prima-facie case were in effect required to lay on a full-dress rehearsal of the claim and the defence; indeed, this was what had happened in this case. Such an approach was inappropriate for an application to bring proceedings. Parliament must be deemed to have been aware of the court’s jurisdiction to strike out a claim under Order 18, rule 19, of the Rules of the Supreme Court, and to have intended to provide those who operated under the Mental Health Act with some further protection; but-this did not mean that an applicant had to show a case far stronger than one which would be struck out. The aim of s 139 was to establish a balance between the legitimate interest of the applicant to be allowed to bring a claim which was not frivolous or vexatious and the equally legitimate interest of a respondent not to be made the subject of the undoubtedly exceptional risk of being beset by baseless claims by patients treated under the Act. The issue for the court was not whether the applicant had established a primafacie case or even whether there was a serious issue to be tried,
An editorial on p 755 looks at some questions that have been voiced lately about the medical and nursing care of persons held in prison in Britain. The following outline of the services as they exist is offered as a factual supplement to the editorial
the provision of reports to courts (over 9000 were supplied last year); the organisation and provision of general medical services (over 1 million professional contacts last year); and referrals to specialist services (100 000 last year). Their other tasks include preventive medicine and environmental health, occupational health, and advice to management on such matters as nutrition and sanitation. In the past 2 years, the recruiting position has improved from 27% of posts vacant to only 3%. During this time, some 90% of appli-
THE Prison Medical Service in Britain derives from the work of John Howard, the prison reformer of the late 18th century; and it was set up, largely in its present form, in 1877. Its medical officers are Civil Servants and it is administered by the Prisons Department of the Home Office. It thus predates the National Health Service and was left untouched when the NHS began in 1948. Just over 100 full-time medical officers cover the four regions of the countrynorth, midlands, south-west, and south-east. There are also about 100 part-time medical officers and some locums. Many NHS specialists of all disciplines provide support by prison visits and by receiving prisoners as outpatients or inpatients. The great majority of part-timers and locums are NHS general practitioners who practise near prisons. Thus, most of the clinical work in prisons is performed by doctors whose main professional employer is the NHS. The full-time medical officers are either those with postgraduate specialty qualifications and experience in psychiatry, particularly forensic psychiatry, or those experienced GPs who have joined the Service, often in mid-career. Of the 26 medical officers recruited in the past two years, 14 had postgraduate specialist qualifications (11were members of the Royal College of Psychiatrists), 7 were principals in general practice, 2 had long experience in treating drug addiction, and 3 had passed part 1 of the MRCPsych examination and wished to complete their qualification. The role of full-time medical officers con-
A vital part of the Prison Medical Service is the work of the hospital officer and nursing staff. The hospital officers, providing nursing care for male prisoners, number about 1000, and the total will rise as new establishments open. 2 years ago, 68 of the 840 hospital officers in post held a nursing qualification: at present 110 of almost 1000 are so qualified. At the moment planning aims at raising the proportion of the nurse-qualified to 360 out of 1200 in the next 3 years. Hospital officers receive 24 weeks’ basic training, followed by continuing instruction after appointment to a post. There are many similarities in needs and organisation to training requirements in comparable parts of the medical structure of the Armed Forces. The 200 nursing officers, who (unlike hospital officers) are not trained in security measures, are qualified as nurses and provide nursing cover for women in prison (about 1600, or 3% of the prison population). Members of the nursing service do not wear prison service uniform. While carrying out their duties, they often require escort by discipline officers, in circumstances which vary from establishment to establishment. Completing the Prison Medical Service, 16 pharmacists work in the major prison establishments and supervise pharmaceutical supplies to their own prisons and to neighbouring satellite prisons. Each dose of medication is given to the patient or inmate separately so that its administration can be effectively supervised.
cerns :
Prison Medical Service
Medicine and the Law When Can a Patient Sue for Negligence and Wrongful Detention under the Mental Health Act? IN order to protect doctors from the real or imaginary threat of a flood of actions by aggrieved persons treated under the Mental Health Acts, the law requires that a mental patient must obtain the leave of a High Court judge before he or she can bring an action to sue a doctor and/or a health authority for alleged negligence and wrongful detention, &c. Under section 141 of the 1959 Act, doctors and health authorities were so protected that such a patient bent on suing had a much more difficult task to obtain the leave of the court than did a vexatious litigant. Section 141 required the patient to demonstrate a very substantial prima-facie case before the court could grant leave to proceed with the action. The intention was, no doubt, to deter disgruntled mental patients with imaginary claims from suing their doctors for alleged ill-treatment or negligent false
imprisonment in hospital. Routley v Vaudrey and others! illustrated clearly how onerous the requirements were before a person could sue under the Act. The position has been vastly changed, however, by s 139 of the 1983 Act (which replaces s 141): the patient is now no longer required to make out a substantial prima-facie case. The correct test today, as lately propounded by the Court of Appeal in Winch v
Jones and others &c,2 is whether, on the material before the court, the patient’s complaint appears to merit fuller investigation. In Winch v Jones, the Court of Appeal has allowed two appeals from Mr Justice Otton’s refusal to give a patient leave. In a leading judgment, Sir John Donaldson, Master of the Rolls, said that the applicant had claimed that the respondent doctors had been 1. Brahams D.Proceedings for false imprisonment and negligence under 1959 Mental Health Act.Lancet 1983; ii: 466. 2 SeeWells W.Negligence and the Mental Health Act.Lancet 1985; ii: 547.
cants were
unsuccessful.
negligent when they recommended her admission to and continued detention in the North Wales Hospital, Clwyd, under s 26 of the 1959 Act. Although the patient had been detained under the 1959 Act, it had since been repealed and s 141 had been replaced by s 139 of the 1983 Act and (by para 28 of Schedule 5 of the 1983 Act), it was s 139 which now applied to her claim. Section 139(2) merely provided that "no civil proceedings shall be brought without the leave of the High Court ..." The removal of the previous words which required the court to be satisfied of "substantial ground for the contention that the person to be proceeded against has acted... without reasonable care" amounted to a considerable change of approach by the court. Mr Justice Otton had concluded that the applications were not frivolous or vexatious nor were they an abuse of the process of the court. He concluded, however, that he should not grant leave, because a prima-facie case of negligence had not been established against each of the two doctors sued. For the patient it was argued that the test should be whether there was "a serious issue to be tried". The Master of the Rolls said that’s139 required an individual approach. Claimants who had to show a prima-facie case were in effect required to lay on a full-dress rehearsal of the claim and the defence; indeed, this was what had happened in this case. Such an approach was inappropriate for an application to bring proceedings. Parliament must be deemed to have been aware of the court’s jurisdiction to strike out a claim under Order 18, rule 19, of the Rules of the Supreme Court, and to have intended to provide those who operated under the Mental Health Act with some further protection; but-this did not mean that an applicant had to show a case far stronger than one which would be struck out. The aim of s 139 was to establish a balance between the legitimate interest of the applicant to be allowed to bring a claim which was not frivolous or vexatious and the equally legitimate interest of a respondent not to be made the subject of the undoubtedly exceptional risk of being beset by baseless claims by patients treated under the Act. The issue for the court was not whether the applicant had established a primafacie case or even whether there was a serious issue to be tried,