DEATH OF DIGNITY IN A JAIL CELL
A prisoner with terminal cancer and a clash between a governor and nurse manager who decided he die in his cell
TERMINALLY ill prisoners should have full access to palliative care rather than dying behind bars, the Justice Minister has said.
Charlie Flanagan was responding to a report into the death of 47-year-old ‘Mr P’ in the Midlands Prison in 2018, despite a recommendation by the Minister that he receive palliative care.
The inmate was in the late stages of cancer when a prison governor and a senior nurse manager in the Prison Service disagreed over whether he should be allowed to die in prison under expert care or in a hospital setting.
Commenting on the Inspector of Prisons’ report, Mr Flanagan said: ‘That was a very sad experience and I offer my condolences to his loved ones.’
Noting that as Justice Minister, he had approved hospital and medical treatment outside the jail, Mr Flanagan added: ‘It would have been preferable from a humanitarian point of view if he spent his final days in the more comfortable surrounds of a hospice or palliative care bed.
‘Every effort must be made by the State service providers in Health and its agencies that this sad experience is not repeated.’
The Minister’s concerns were echoed by two prison governors and staff within the jail who dealt with ‘Mr P’ in his last days.
The report, which was published and laid before the Dáil on May 8, stressed that the end of life care ‘Mr P’ received in the Midlands Prison was commendable.
Every effort, it stated, was ‘made to make him comfortable and he was treated with as much compassion and respect as was possible on a busy prison wing’.
However, the report noted this was challenging for staff who did not ‘have the necessary equipment or personal care materials to care for a dying man’.
It was also difficult for his family who were ‘brought in to visit just before he passed [but] could only see him in his cell, which meant the visit could only take place when some 50 other prisoners on the wing were locked in their cells’.
The report noted: ‘These practical burdens on IPS staff and the family would have been unnecessary if Mr P had been afforded the opportunity to die in a hospice, rather than in prison.’
The deceased prisoner’s sister had also asked why ‘Mr P was not being given the opportunity to die in a hospice setting rather than a prison cell. She felt this was very unfair.’
The prisoner, who was jailed in May 2017, was serving a long sentence and lived on G1 wing where he had enhanced status.
However, on October 11, 2018, after treatment for cancer, a case conference of doctors decided ‘he had between two and three weeks to live’.
The report noted: ‘This case conference represented a positive planning event’ which had agreed that a query should be raised about the possibility of a hospice place for Mr P.
But following ministerial approval, he continued to be cared for in Portlaoise General Hospital until his discharge back to the Midlands Prison on November 8, 2018.
One witness, Nurse Manager A, reported that there was a discussion between the Community Palliative Care Team and Portlaoise General Hospital regarding Mr P’s need for hospice care and he remained in hospital while this took place.
Ultimately, however, a consultant’s clinical opinion that Mr P did not require an acute hospital bed meant that he was discharged.
This, the report noted, created the scenario where the ongoing absence of a community hospice bed meant the only dignified response the IPS could afford Mr P was to make the best possible arrangements for him to be nursed in the Midlands Prison.
This occurred despite contact from Portlaoise General Hospital recommending palliative care.
The report noted in this regard that: ‘On 1st November 2018 Dr A wrote to the Midlands Prison governor saying, “Mr P was transferred to Portlaoise General Hospital (PGH) on 25th October… and this episode of care continues.
“Further he has not been deemed medically fit for a return to prison at this time… He is now at the end of life stage of cancer and following a review by the Palliative Care Consultant, it was recommended from a clinical perspective that he remain in PGH, awaiting a bed in a hospice facility… life span is a very short period indeed.
“Therefore, I am making a recommendation under Rule 105 of the Prison Rules that Mr P be granted Temporary Release as per IPS Compassionate Temporary Release on grounds of Health and Capacity Policy, 2017”.’
The next day, November 2, 2018, the governor received an email from Assistant Principal A to say the minister had approved hospice care for Mr P and ‘things had been set in motion’.
However, despite these interventions, ‘Mr P’ was not transferred to a hospice or a nursing home.
Instead, on November 8, 2018, at 8.07am the Irish Prison Service National Nurse Manager A emailed the Midlands Governors.
She noted: ‘After much discussion yesterday Mr P will be returning to the Midlands Prison today at about 10am.’
The report said the ‘email set out various practical arrangements: a special mattress and a profile bed were to be provided, prescriptions were in place; an agency was supplying a healthcare assistant on a 24-hour-a-day basis and the Palliative Care Team were also available when required.’
Seven minutes later Governor B emailed back: ‘As discussed yesterday, I do not believe that it is appropriate that this man dies in prison and I would be grateful if you and your team make whatever arrangements are necessary to have him transferred to a more suitable palliative setting.’
The governor added: ‘A death in prison is hugely distressful on all involved – the man himself, his family, the other prisoners on his landing and the prison’s staff. It should be avoided if at all possible.’
This, the report said, ‘was a compassionate and sensible suggestion’.
It subsequently noted that Governor B was made aware on Tuesday evening, November 13, 2018, that the prisoner’s death was imminent.
He asked Chaplain A to inform Mr P’s family and invite them in to see him that evening.
His father, a brother and sister came in at 7.30pm. Although it is reported that they were uncomfortable being in a cell, they spent around 35 minutes with him.
Governor B visited Mr P in his cell the following morning and found him unconscious, and his breathing laboured.
He again requested an assessment by the Palliative Care Team to determine whether Mr P could be moved to hospice care, but, at 2.30pm he was very close to death and at 2.50pm it appeared he had passed away.
The report said: ‘Chief Officer A’s informative, factual report said ‘…I do not think it is appropriate to have any prisoner at end of life to be held in custody.’
This view was echoed strongly by a Critical Incident Review which took place at 3pm on November 16. At the review, the report notes: ‘Governor A said, “Prison is not an appropriate place for someone to die and we hope it will be the last”.’ Chief Officer A is quoted as saying: ‘This is a horrible place for someone to die.’
Governor A also said in the future it is likely the Irish Prison Service ‘will be more open to prisoners going to a hospice’.
The report also recommended that the IPS should consider bringing in a policy that requires a prisoner’s written consent to confirm they don’t want to be resuscitated.
‘Staff were not equipped to care for dying man’
‘He has not been deemed fit for a return to prison’