Whistleblower sounds the alarm on inadequate prison healthcare

A general practitioner has filed a 25-page complaint with the Belgian Medical Association, condemning a series of serious shortcomings in healthcare at Haren prison.

Doctor Brecht Verbrugghe spent months compiling the evidence presented in the complaint, describing the problems as structural.

Issues include shortcomings in the screening and treatment of hepatitis C and tuberculosis, care that is avoided under the pretext of the logistical burden it entails, structural breaches of medical confidentiality, and a lack of vision and debriefings in the event of serious and traumatic incidents.

Healthcare for prisoners must be "equivalent" to that provided to people outside prisons, according to the guidelines of the Directorate-General for Penitentiary Institutions (DG EPI), but Verbrugghe said that this was rarely the case.

Instead, working conditions are shameful, patients are often left to their own devices and healthcare providers are powerless against an administration that focuses on punishment and control, according to the doctor.

These shortcomings in healthcare also fuel the already prevailing tensions between staff and prisoners, Verbrugghe argues.

"Doctors need to take a stand on these ethical issues: we are doctors, we are healthcare professionals, we are not security guards," he said. "It’s important to uphold our professional ethics."

In the complaint, Verbrugghe noted lax attitudes from colleagues and a tendency to view people as "prisoners" and not "patients", citing one doctor who conducted most of his consultations from behind his desk, relying on notes, without questioning or examining the patients.

“After several years in prison, I now understand that the environment makes you slip up faster than you would have thought possible,” Verbrugghe wrote, describing administrative and practical challenges to the job.

“First of all, it takes 15 minutes just to get into the prison. Then you have to work with a computer system that’s completely outdated, and you have no access to patients’ files or medical histories.”

Verbrugghe said that on a typical day, a prison doctor has a list of patients to see and must also visit the "punishment cells", also referred to as "the dungeon", where inmates are supposed to be seen by a doctor within 24 hours of placement.

“It's very difficult to assess someone who’s in the dungeon – if there are 10 cells, it will take all day,” said Verbrugghe.

“I know that I won't be able to see half of the patients for one reason or another. Not to mention professional confidentiality when consultations have to be held with the door open. We are constantly subject to the logic of the prison.”

Verbrugghe also noted difficulties in getting appointments with specialists: “In a free society, there are also waiting lists, but here the delays are abnormally long.

"And when you finally get an appointment, the transfer can't happen because there aren't enough staff or because there's a strike. The appointment is then cancelled, but we’re not informed. Under these conditions, how can we ensure quality care?"

Some sick prisoners wait weeks to be treated and it becomes too late for medical interventions. Verbrugghe described a patient who complained of abdominal pain for more than six months and eventually died from what turned out to be cancer, along with another prisoner who died while on a waitlist for a consultation after being unable to see a doctor on two different occasions.

Verbrugghe said the only reason that there are not more deaths is because many prisoners are young and therefore generally in better health at the time of their incarceration.

Unlike in a psychiatric hospital, where deaths or other negative medical outcomes are rigorously investigated with the goal of prevention, Verbrugghe said the prison has no such protocol: “For me, it's violent. It's institutional violence.”

The prison administration denies this is the case, saying that when an inmate dies, a forensic doctor is called in to examine the body and "if deemed necessary, an investigation is conducted, which may lead to prosecution if appropriate".

“The doctor is a whistleblower,” said Robby De Kaey of the ACOD union. “He’s bringing to light a problem that has existed for some time but has not been resolved. What I read does not surprise me.”

Unions will meet again with the prison service and the office of justice minister Annelies Verlinden (CD&V). Overcrowding and staff shortages in prisons are standard items on the agenda, according to Frank Conings of the ACV union.

Conings said that new prisons, such as the one in Haren where reports of inadequate dental care are commonplace, often suffer from teething problems.

“It can take up to five years to achieve healthy and balanced operations,” says Conings, adding that this is why it is asking for staff to be recruited and trained in advance for the new prison in Antwerp.

Verlinden said she was committed to "humane detention" and pointed to the construction of Forensic Detention Centres (FDCs), which will accommodate prisoners with mental health issues. According to the minister, their numbers are increasing in prisons, while they actually belong in specialised centres or wards.

In order to better meet these needs in the future, the prison in Haren is starting a pilot project with a Clinical Observation Centre which will assess whether prisoners need specific guidance.

But the opening of the other Forensic Detention Centres is not scheduled until 2030 at the earliest – a date which could change as a result of permit and construction issues that often arise with projects of its kind.

In the meantime, the prison service has invited doctors who have reported abhorrent working conditions to the media for a meeting that aims to "discuss the issues in detail and see what can be done differently and better", according to spokesperson Kathleen Van De Vijver. An investigation is also being launched by the Medical Association.

Following the complaint from the whistleblower, the prison service indicated support for the transfer of healthcare in prisons from the justice ministry and public health ministry.

“We very much welcome the request to transfer prison healthcare to the public health system and are working on this in a constructive manner,” the service said in a statement.

“As far as we are concerned, this could certainly become a reality very quickly.”

Photo: Hatim Kaghat/Belga