Access to medication a common concern in institutions, former correctional investigator says

Canada's former correctional investigator says a Winnipeg couple who are worried for their son's safety after the city's Remand Centre refused to accept the prescription medication they dropped off for him are not alone.

"For the 12 years that I was the Correctional Investigator of Canada, the No. 1 concern brought to my office for investigation was access to and quality of health care, and a lot of those concerns were around medication," Howard Sapers said on CBC Manitoba's Up to Speed on Friday.

Earlier this week, the family of Jonathan Griffiths-Walker, 22, told CBC that staff at the Winnipeg Remand Centre refused their son's prescription medication when they dropped it off at the institution for him after he was taken into custody Wednesday evening.

Griffiths-Walker has been diagnosed with attention deficit disorder, fetal alcohol spectrum disorder and oppositional defiant disorder, and currently takes three separate medications for his conditions.

Staff at the Remand Centre told his mom and her husband the doctor was prescribing only one of them and would not be administering the other two.

Sapers, now the independent advisor to the Government of Ontario for corrections reform, said he couldn't comment on Griffiths-Walker's case specifically. But he said in general, doctors in the institutions have both the right and the responsibility to use their clinical judgment when it comes to meeting the health-care needs of inmates, including writing prescriptions.

"Even if you go from one doctor to another in the community, you might get a second opinion. That happens in corrections all the time," Sapers said.

Sapers also said certain medications create more "security risks" than others within institutions: opioids, methadone and some psychotropic medications used for mood disorders can all be diverted into a drug trade within the institution.

"Most contraband drugs within an institution are in fact not illegal drugs that are being smuggled into an institution but they're diverted medications," Sapers said. "So that is a real security challenge."

For that reason, Sapers said corrections doctors have fewer options for medications they can prescribe than doctors in the broader community.

But changes to prescription medications as inmates enter and exit institutions can affect their therapeutic value, Sapers said, creating disruptions and sometimes increasing risk of elevating a psychotic disorder, or otherwise making existing conditions worse.

"So the question is, what are we doing to facilitate communication and continuity of care? And that's a question of bringing two systems together: the health-care system and the corrections system."

Sapers said he's seen an increase in the prevalence of people in custody with mental health issues, so it's important to get health care right.

Some areas in Canada and internationally have had success by handing correctional health care over to the health ministry in the region, instead of having it run by the correctional service.

Sapers said it's important to address the issue at a macro level, instead of tackling it on an ad-hoc basis.

"Where we've seen success is where you get people sitting down proactively and not responding to a particular crisis or a particular case, but working out protocols and information sharing agreements," he said. "Not in the context of one particularly problematic case, but as a regular way of doing business."