Consulting psychiatrist Louis Thériault speaking to reporters inside Dorchester Penitentiary on December 19th

A Moncton psychiatrist, who has being doing part-time consulting work at Dorchester Penitentiary for 25 years, says the announcement of a new, 155-bed health centre there is long overdue.

“This is quite a challenging place to work,” Dr. Louis Thériault said last month as reporters toured the 53-bed Shepody Healing Centre in Dorchester’s medium security wing that treats male inmates for both mental and physical ailments.

He pointed to the many ways that Shepody is inadequate to treat inmates with histories of being sexually abused and brutalized and who suffer from severe mental conditions such as personality disorders and schizophrenia.

“These patients are severely traumatized,” he said, adding that Shepody, which is spread over several floors in the 145-year-old prison, is far too cramped and outdated to provide proper therapy.

For one thing he says, climbing stairs to get to healing centre cells makes it challenging for older inmates who need wheelchairs, while a room where mental health staff conduct interviews is tiny and unsafe.

“We should have an occupational therapy room,” Thériault said, adding that the new centre, which is expected to be ready in seven to 10 years, will be a significant step forward.

“We’ve been talking about it for over 20 years,” he said.

He spoke shortly after federal Finance Minister Dominic LeBlanc announced that the government had allocated about $1 billion for what he called a Health Centre of Excellence that would treat both male and female inmates from across the country in the Dorchester prison.

Federal Finance Minister Dominic LeBlanc announcing new health centre at Dorchester Penitentiary. Photo: Correctional Service of Canada (CSC)

“So you understand the scale of the project, the Treasury Board last week approved an investment which will be one of the largest investments the government of Canada has made in New Brunswick since the Confederation Bridge was built,” LeBlanc told reporters referring to the PEI crossing that cost about $1.3 billion.

At the same time, however, he acknowledged that the new centre would not solve all of the problems identified in reports stretching back over decades.

In a 2013 speech, for example, Howard Sapers, the former Ombudsman for federal prisons noted that prisoners often complained about their lack of access to medical treatment.

“Health care remains the single most frequent area of offender complaint to my office,” he said, adding that inmates frequently expressed concerns about lengthy delays in getting treatment.

“It is no secret that the inmate population is disproportionately comprised of persons from disadvantaged or vulnerable backgrounds,” Sapers said.

“Offenders often arrive in prison with chronic or unaddressed health conditions. Their poor physical health is frequently exacerbated by histories of trauma, substance abuse or addiction issues, co-morbidities that are common among those living on the margins of society.”

In its 2021 report, the Senate Committee on Human Rights said it was “deeply troubled” that the “physiological and mental health issues of many federally-sentenced persons are not being met” partly because “doctors, psychiatrists, and dentists are only contracted to work a restricted number of times weekly or monthly.”

And, in a 2021 opinion piece headlined, “When your jailor oversees your healthcare, neglect and torture inevitably ensue,”  Leandra Keren of the John Howard Society writes that because of Correctional Service of Canada (CSC) concerns about costs and security, “federal prisoners wait months to see a physician” who may deny them needed prescriptions:

In the eyes of CSC, medical staff, prescription drugs, and specialist consultations, all constitute major costs which detract from CSC’s budget. The fox is providing the hens with healthcare. This, along with the punitive culture of prisons, results in the mistreatment of prisoners through the denial of their healthcare.

One of the five beds in Dorchester Penitentiary’s Shepody hospital. Photo: CSC

Both the present Ombudsman, Ivan Zinger and the Senate Committee point out that health care in federal prisons does not meet international rules requiring that inmates receive the same standards of care available to the general public.

Instead of being covered by the Canada Health Act as other Canadians are, inmates receive “essential health care” and reasonable access to “non-essential” care provided by the Correctional Service of Canada.

Neither “essential” nor “non-essential” health care are clearly defined in the law that governs prisoner health care leaving it up to CSC to decide the level of care that will be provided  instead of offering treatment based solely on patient needs and the independent assessments of medical professionals.

The Senate committee report points out that federal inmates are vulnerable because they depend on CSC to meet their health-care needs.

“When those needs are not taken seriously, the repercussions can be disastrous,” the committee wrote. “Access to health care is not a privilege, it’s a right.”

The committee recommended that CSC work with provinces, territories, medical associations and medical licensing bodies “to ensure professional standards are adhered to and doctors are available in federal penitentiaries on a full-time basis and registered nurses on a 24-hour basis.”

It also recommended that CSC establish a policy to ensure that only medical professionals have the authority to determine whether an inmate needs medical attention.

During the media tour of the Shepody Healing Centre last month, I asked Dominic LeBlanc if the federal government would consider changes:

Q: Most Canadians do not know that once you enter as an inmate in a federal prison, you’re not covered by the Canada Health Act. You’re covered by another Act that empowers CSC to provide your medical care. It requires them legally to do it. And that puts CSC in a conflict of interest because they have to worry about budget constraints and security and all the other issues. So would your government consider putting the inmates legally under the Canada Health Act provisions, which guarantee universal access to Canadians?

A: I don’t know the answer to that. I haven’t heard that question expressed that way. I’m not trying to be disagreeable. I don’t agree with the premise of the question that they [CSC] are in a conflict of interest. They’re no more in a conflict of interest than the Vitalité Health Authority is when somebody shows up in the emergency room of the Dumont Hospital in Moncton tonight. So I think we have an obligation to provide public health care…I recognize we need to raise health-care services across the Correctional Service of Canada. And if that idea would help, the provinces are very quick to point to the Government of Canada downloading health care services on them. They want more money and less patients. That’s something that’s been as old as Confederation or since we’ve had a public health care system in Canada. But my view is that the Correctional Service of Canada has to do the best job possible. That means facilities, professionals, people, staff, and it means access to the appropriate treatments. And the Government of Canada has to give them the funding to do that properly. And maybe that will be a benefit of my becoming the Finance Minister.

Both tables from the Annual Report of the Office of Correctional Investigator (Ombudsman) 2014-15