Expert Evidence: Prison Medical Negligence

Unveiling the Hidden Crisis: A Deep Dive into Medical Neglect in Correctional Facilities

The physical health of people in prison falls far below that of the general population. For instance, cases of tuberculosis per 100,000 are over five times higher among the prison population. Hepatitis C is more prevalent among prisoners, especially women inmates, compared to the general population (13% of female prisoners and 7% of male prisoners have Hepatitis C compared to 0.4% of the general population). Prisoners are also more likely to suffer from respiratory conditions and Musculo-skeletal disorders. Given these stark statistics, alongside drug and alcohol addiction, pregnancy, and mental health issues, all of which can affect people in prison, medical negligence can and does occur. And if a medical negligence claim is brought, both the Claimant and Defendant will often require expert evidence from GPs and other healthcare professionals to assist the Court with making a decision.

Prison Medical Negligence

What are the reasons for prison-related medical negligence cases?

The mortality rate of prisoners is 50% higher than the general population. Dr O’Moore from Public Health England told a Commons Select Committee that this stark figure:

[ … ] represents the complex vulnerabilities that people have that they bring with them into prison, and then you are in an environment where maybe some of those needs are not well understood or well met. So, people presenting with particular signs and symptoms of disease or problems are not being managed in a particular way that one would expect.

The 2015 United Nations Standard Minimum Rules for the Treatment of Prisoners, known as the Nelson Mandela Rules, puts an onus on all governments to ensure that imprisonment of their citizens is reasonable, proportionate, decent and humane, and that the health of those held in custody should not deteriorate as a consequence of the prison environment or its regime.

In England and Wales, approximately 160,000 people are held in custody each year, and almost a quarter of them (24.4%) reside in crowded conditions. The prison population is also aging – the over-60 prison population rose by 243% between June 2002 (when records begin) and March 2020, from 1,511 to 5,176. Add into this mix chronic staff shortages and budget cuts and you have a recipe for serious medical negligence incidents.

The case of Aisha Cleary

A case that highlights how pressures on the prison system can lead to medical negligence is that of Aisha Cleary. Aisha’s mother, Rianna was a vulnerable teenage care leaver, who gave birth to Aisha alone in a prison cell one night in September 2019. Aisha was found dead in the cell the next morning. Expert evidence presented to the Coroner was unable to conclude whether the infant had been stillborn or had died post-delivery.

The Coroner concluded that the lack of appropriate care plan put in place for Rianna by prison or healthcare staff was a “significant missed opportunity” to engage with and monitor her. Evidence showed that despite a recognised risk, midwife and obstetrics services at HMP Bronzefield:

  • Did not provide any guidance to prison staff.
  • Failed to work with prison healthcare staff in the form of establishing multi-disciplinary meetings and ensuring there was an effective plan to identify when the teenager was in labour so she could be transferred to a hospital.
  • Prison staff did not respond to Rianna’s calls for medical assistance.

Medical Expert Witnesses also provided valuable evidence in the recent decision in R (on the application of Davies) v HM Deputy Coroner for Birmingham [2003] EWCA Civ 1739. Although the case was not one concerning medical negligence, it highlights how medical experts can aid the Court in difficult cases where best practice may not have been followed and this allegedly led to the injury or death of a prisoner.

The case concerned the death of a prisoner who was addicted to heroin at HMP Birmingham. He was suffering from withdrawal symptoms at the time he entered the prison and failed to take any detoxification medication. When his symptoms worsened, he was visited by a nurse, who judged that he did not need further medical assistance. The prisoner died the following day.

Four doctors were called on to provide expert evidence. All concluded that the death was unusual and, although it could not be said for certain, the prisoner likely died from dehydration caused by excessive diarrhoea and vomiting as opposed to drug withdrawal.

In a written expert report, one of the doctors called to provide evidence was critical of the nurse’s actions, concluding:

  • She did not elicit all the available information about the inmate’s vomiting and diarrhoea, or about the absence of food or fluid intake, or about the fact that he had not taken any of his prescribed medicine.
  • The above circumstances should have led the nurse to discuss the case with the duty doctor.
  • The nurse should have been able to move him to an area for closer health care supervision. HMP Birmingham did not possess such a resource since in-patients are not monitored by health care staff through the night.
  • The prisoner’s collapse in the early hours of the morning was highly unusual. There should have been discussion with the duty doctor, and arrangements for closer monitoring. This was not done.

Concluding comments

Expert evidence in prison medical negligence cases is crucial for several reasons, including:

  • The poor physical and mental health of many of those who are incarcerated, and the high incidents of overcrowding provide an environment ripe with opportunity for injury and illness to occur. Experts can provide an opinion into the cause of a prisoner’s illness/injury and their expected prognosis.
  • The Claimant prisoner may have multiple people from different agencies assigned to monitor their health and welfare. For example, social services, midwives, obstetricians, and prison staff were involved with Rianna Cleary and it could be argued that all failed in their duty to her at some point. In such complex cases, Counsel for the Claimant and Defendant/s would need to rely on expert evidence to unpick the trail of responsibility and identify where the failings (if any) lay.
  • Few members of society understand or frankly care about prisoners’ plights, in fact, prison budget cuts are often seen as a good thing by some in the electorate. Medical negligence cases are one of the few opportunities where failings in the prison system can be highlighted. Although this is certainly not their focus, an unintended benefit of an expert witness’s testimony can be that prison welfare policies and procedures are changed for the better.

Searching for a GP Expert Witness?

We have several GP Expert Witnesses who work in prisons and can provide expert reports and testimony in prison medical negligence cases. If you would like to learn more about how our GP Experts can assist in your medical negligence claim or defence, please call us on 01865 587865, email, or request a call by completing our online form. We will arrange a time for you to speak to our GP Expert Witness who will listen to the case details and advise the best way forward.