For doctors working on the oncology ward that treats Victoria’s prison population there is just one golden rule: don’t Google the patients.
After two decades on the ward at St Vincent’s Hospital medical oncologist Dr Genni Newnhan is used to seeing patients shackled, handcuffed and flanked by security guards on their way to their three-month check-up.
High profile criminals, she’s treated a few, but the medical oncologist is not naming names, and she says she makes a point of not learning the reason behind a patient’s incarceration, simply to “protect my mental health”.
“There are trainees that have Googled people and then been quite distressed,” she explains.
“I figure we have got our own judicial system and this person has been tried and they’re being punished for whatever it is that they did. My job is not to determine whether they are worthy of healthcare or not, my job is to provide healthcare to the patient who turns up to see me, whoever that is.”
As the tertiary centre caring for the state’s prison population, St Vincent’s Hospital in Melbourne’s Fitzroy has a dedicated locked ward, but shackled prisoners are also brought in as outpatients.
The majority are men with skin, lung, bowel and primary liver cancer.
But for some time, Dr Newnham and her colleagues have worried about the barriers to care faced by prison inmates, resulting in missed appointments, treatment refusal and prisoners who are released mid-treatment dropping out of care.
In an attempt to investigate their concerns, the doctors have carried out a retrospective review of this group dating back 15 years as well as a more detailed assessment of cancer care timelines for 100 patients treated in the past five years.
The aim, she says, is “to see if we have been meeting recommended treatment time frames and explore recurring themes for not meeting time frames if we were not”.
These findings will be presented at the Correction Services Healthcare Summit in September.
“Anecdotally over a long time we have all been repeatedly frustrated at what we felt were probably sub-optimal treatment and treatment outcomes for prisoners just because of the logistics of treating them,” Dr Newnham tells the limbic.
The majority of cancer care is outpatient-based, she explains, with an initial consultation that will generally cover diagnosis, treatment options and prognosis. Follow-up consultations involve monitoring and treatment, which often includes IV chemotherapy.
“With prisoners, almost every step of that is much more difficult,” she says.
“Starting from even just your initial consultation, if they come as an outpatient they will come with a guard who will stay for the whole consult and I’m sure it’s appropriate, but it changes the dynamic. I think they are probably not given as in-depth a discussion about their illness.”
In any other first consultation an oncologist will usually give their patient resources to take home and share with family members, but with prisoners the information must be given to the accompanying security guard.
There are other barriers: some people refuse treatment when they learn it will mean they will be transferred to the maximum security Port Phillip Prison for its more extensive medical facilities including pathology and radiology services.
These refusals “trouble us greatly,” says Dr Newnham.
“I’m sure some of them have inadequate care and I’m sure some of them have cancers that might have been curable that are no longer curable.”
Missed appointments and interrupted cancer treatments are also common, with the challenges of co-ordinating transfers to and from the hospital likely to play a big role, she suggests.
“Coming to any appointment relies on there being available transport, room on the bus, guards, no security risk posed by other prisoners on the bus and space at Port Philip in the first place,” she says.
She believes the state’s healthcare and prison system are operating in silos, and this is hampering the delivery of timely care to prisoners.
“We really have very little understanding of what happens after they leave us.”
“The hospital staff, we work within our defined system which has its own inflexibility. Even though we treat a lot of cancer patients we have a very poor understanding of all these extra barriers there are to caring for these people.
“On the flip side, I think the prisons and the people coordinating the movement of the prisoners have very little understanding of the relative importance of where (the patients) are going and why.
“On the whole, the statement from Justice Health is [prisoners] are entitled to the same healthcare everyone else gets, and certainly individually as practitioners that’s what we provide, it’s just the logistics are more difficult.”
Then there are the cancer patients in the prison system who are lost to follow up.
“One of the major difficulties is when prisoners are released we are not providing any forwarding information and they often return to reasonably disorganised lifestyles and are lost to follow up.
“Then they only present for medical care when they are really unwell or return to prison so there is another gap there.
The hospital has systems in place to remind patients about upcoming appointments: there are reminders sent by SMS and in the post.
“If we don’t have a phone number and we don’t have an address or a next of kin then we just have no way of finding them,” says Dr Newnham.
But if the problems are systemic, she says, then they have the potential to be solved, something she hopes her research will elucidate.
“This project has already resulted in an improved understanding of the barriers to caring for this unique population, however that information is held by a relatively small group of interested individuals.
“I hope that we will be able to expand dialogue both within the hospital, and between the hospital and Justice Health to ultimately establish a greater shared understanding and more transparent processes surrounding the care of prisoners in Victoria.