11th May 2020
Mr P was aged 47 when he died in the Midlands Prison on 14th November 2018. His illness had been diagnosed four months earlier, just over a year after he was sent to prison. On 11th October, medical opinion considered he had between two and three weeks to live.
Mr P was transferred to hospital by ambulance on 25th October. Although hospice care was approved for Mr P by the Minister on 2nd November, there was no community hospice bed available at the time. Mr P returned to Midlands Prison on 8th November on his release from hospital, where he remained until his death. Mr P’s next of kin questioned why Mr P was not given the opportunity to die in a hospice setting rather than in a prison cell.
The report states that continued efforts were made to secure a hospice bed, and a community palliative care team, as well as extra nursing and HCAs, were put into place to offer care in a prison setting. While every effort appears to have been made by all staff in Midlands Prison – as noted in the Inspector’s report – the prison staff did not have the equipment to care for a dying man.
Available evidence suggested Mr P had stated he did not want to be resuscitated. There was no Do Not Resuscitate (DNR) policy in the prison and he had not signed anything to formally consent to this. This issue, it was reported, caused anxiety for healthcare staff.
There was one recommendation stemming from the Investigation Report into the death of Mr P. The Inspector recommended: “The IPS should consider introducing a policy that would require written consent by a prisoner to confirm their wish not to be resuscitated. Appropriate safeguards should be put in place to ensure that such consent is fully informed and provided freely.” The Irish Prison Service has responded to the Inspector’s recommendations in an Action Plan published alongside the report, showing that the IPS are in the process of developing an End of Life Care Policy.
Eighteen months elapsed from Mr P’s death to the publication of the investigation report. IPRT reiterates that investigations into deaths occurring in prison custody must be prompt to ensure that any systemic issues are identified and addressed in order to prevent potential future deaths. IPRT remains concerned about delays in publishing these reports, which play an important preventive and improvement role.
IPRT strongly believes that prisons are not suitable for end of life care and should be avoided in these situations, if possible. A death in prison is not dignified for the person, and is distressing for their family, other prisoners, and prison staff. The Council of Europe (2019) has highlighted that even the normal prison environment amounts to inhuman and degrading treatment for those with terminal illness.
Midlands Prison, where the death of Mr P occurred, is inadequate to house people with complex medical needs – despite the best efforts of dedicated staff. Cell-sharing is a common feature, with stairs throughout the prison. Although plans exist to reopen the former Training Unit as a facility for older prisoners, IPRT believes that the Training Unit, in its current form, is largely inadequate for older people due to the lack of in-cell toilets. Although we welcome that the Irish Prison Service is taking measures to address the needs of older prisoners, it is important that this move does not result in housing people with complex medical issues in the prison system for longer than is necessary.