A medical cadre for correctional homes
The State is both the health provider and the sentence implementer for prison inmates. It needs to ensure swift and quality treatment of illness — physical and mental — for them
Thank God for the Right to Information (RTI) Act and thank God, too, for Aruna Roy who was its chief initiator, and Wajahat Habibullah, who, as the first Chief Information Commissioner, set its standards high. Responding to a recent RTI query filed by an advocate in Madurai, KR Raja, a reply came saying that between January 2022 and February 2024 — a space of two years — 118 inmates in five central prisons – Madurai, Coimbatore, Tiruchirappalli, Cuddalore, and Vellore — died. The query related to these prisons located in Tamil Nadu but there is no doubt that the statistics are not a reflection on central prisons in that state. They would be found to apply all over India. And there is no suggestion in either the query or in the reply that there was anything to the deaths other than illness and death.
But reading the report I could not help having the following thoughts.
Prisons — now appropriately called “correctional homes” — are where the homemaker is the State. The difference between these homes and any other residence is that its inmates are not there of their own accord but because they are either undergoing a trial for one or another offence under the IPC or have been convicted for a term in those “homes”.
This arrangement casts two responsibilities on the homemaker, namely, the State: One, to ensure that the processes of lawful penology are observed and the inmates are confined according to those processes; and two, to also ensure that the inmates suffer no privation (other than their compulsory confinement) which will adversely affect their physical or mental status.
The second responsibility may be regarded and described as subsidiary to and a corollary of the first but it is nonetheless there. The health of the inmates of correctional homes is the responsibility of the homemaker, namely, the State. No confinement, either during the trial or under conviction includes as a part of the arrangement, the additional concomitant of a breakdown in the inmates’ health. No punishment includes inter alia a health breakdown.
Inmates of correctional homes are just as vulnerable and susceptible to illness as anyone anywhere. But two situational issues arise: First, an inmate has no opportunity while housed there, to seek or obtain medical redress of her or his own choice and free will. She or he cannot say, for instance, while in a prison in Delhi, that she or he would like to be treated at AIIMS.
The inmate is at the mercy of the home’s discretion in the matter. Second, the inmate who is unwell becomes at once two entities, a prisoner and a patient. During the incumbency of the infirmity, according to the common laws of prioritisation, the patient supersedes the prisoner for attention. And thereby the homemaker, i.e. the State, becomes a health provider in addition to being a sentence implementer.
As per official statistics, by the end of 2022, India had 1,330 correctional homes of all categories, housing 5,73,220 inmates, 75% of whom were undertrials. These nearly 600,000 human beings are the penological and medical responsibility of the State, whether represented by the central government as in the case of central prisons or the state governments in respect of the others. It is nobody’s case that the State must ensure that these 600,000 human beings do not fall ill. That is not reasonable, not scientific. But it is the undeniable case that the State must ensure the swift and quality treatment of illness, physical and mental, where it occurs, of correctional home inmates.
I am putting the following to my reader and the authorities. India must set up a medical authority exclusively for its correctional homes, making medical expertise a partner of their punitive expertise. Without this, they cannot carry out their second responsibility, namely, their inmates’ medical health. Without such a setup, for instance, the military would be unable to maintain health standards in barracks, cantonments, or units in the field. Medical personnel hold ranks in the military services.
The same should be the case with our correctional homes. Just as there are superintendents and wardens exclusive to them, so should there be medical professionals, including physicians, surgeons, and nursing cadres comprising a medical wing to assist the officers in charge of correctional homes. Requisitioning specialist doctors from “outside” can always be done in emergencies but a standard operating system must be in place.
I can anticipate the reaction: So, you want jails to morph into hospitals, right?
While saluting the healthy cynicism behind that comment, I would say no, I am not doing that; I am only suggesting that our jails should not be thought of as a place where you are confined but also a place where you are left to sicken and, God forbid, follow the 118, whom the RTI reply to advocate Raja showed, on their unintended “journey out” of the home.
At the end of the day, the issue is about how we as a modern society, and the post-colonial State as our society’s most prominent public entity, view our responsibility towards prisoners. Do we look upon them as persons who need the opportunity to emerge from their incarceration as better people? Illness and death in jail have, globally, a morbid history. Kasturba Gandhi died of illness in the British Raj’s custody, with medical aid leaving much to be desired. Syamaprasad Mookerjee died a prisoner in Srinagar, with the nation still unconvinced about the medical aid received by that patriot. Jayaprakash Narayan’s critical illness while he was a prisoner during the Emergency elicited a comment from Dr MK Mani, who later restored him, that saving his life would have been easier had he come to hospital care two weeks earlier.
We are citizens of a Republic not subjects of a medieval order. Our prison reforms are incomplete without a credible medicare component.