Recommendation 161

This recommendation is assigned to CSNSW.

Recommendation

That police and prison officers should be instructed to immediately seek medical attention if any doubt arises as to a detainee's condition.

Context

In the cases investigated by the Royal Commission there were some deficiencies in dealing with medical emergencies, including delays in deciding the take a person for medical attention and actually taking them for medical attention. Recommendation 161 is directed ensuring there are clear instructions for staff to respond  in medical emergencies.

Detail of implementation

Custodial Operations Policy & Procedures (COPP) section 13.2 Medical Emergencies requires staff to immediately call for an ambulance on ‘Triple Zero (000)’ and call Justice Health NSW if an inmate is found unconscious or seriously injured.

According to COPP section, the Officer in Charge of a Correctional Centre must ‘immediately alert a Justice Health NSW nurse or NSW Ambulance if the conversation during [a] cell alarm call indicates that a serious medical emergency is or may be occurring and:

• A correctional officer cannot immediately attend the inmate’s cell; or
• A Justice Health NSW nurse is not available in the correctional centre.’

COPP section 03.07 Managing at Risk Inmates identifies that Court Escort Security Unit (CESU) staff working in police/court cell locations must complete the Brush Farm Corrective Services Academy:

• online e-learning module Awareness of Safe Custody
• face to face course Safe Custody.

The identification and assessment of risk factors for suicide or self-harm begins when an inmate is received into the custody of CSNSW. As risk levels can change rapidly, risk factors need to be assessed on an ongoing basis. Risk factors will be present in a  large number of the inmate population.

There are a number of other risk factors associated with suicide and self-harm. All staff should be aware of these risk factors as identified in the Risk factors for consideration: reference guide.

Detailed information about identifying and evaluating risk of suicide and self-harm is contained in:

• Risk factors for consideration: Reference guide.
• Inmate interview questions to further evaluate risk.

Staff who directly observe or are the first to become aware of any of an inmate showing signs of possible self-harm or suicide must make further inquiries to determine the level of risk. Information to assist investigation can be sourced from the inmate’s presentation, as well as all CSNSW and Justice Health NSW files and database information, particularly OIMS.

Specifically, staff should consider the following sources of information:

• OIMS Alert(s), Disability, Health screens, and case notes
• NSW Police Force (NSWPF) documents - Prisoners/Intoxicated Persons
• Transfer Note and Police Custody Management Record
• Justice Health NSW
• Community Corrections Pre-Sentence Report
• CSNSW Case Management File, including the Inmate Intake Observation (IIO) and Lodgement form and any Health Problem Notification Form (HPNF) provided by Justice Health NSW
•  information from other file documents where available, such as psychology file, Justice Health NSW medical file)
•  staff who are familiar with the inmate (e.g., case officers, Services and Programs Officers (SAPOs), Justice Health NSW, Community Corrections)
• reports from other inmates.
• information gathered from contact with family or external service providers (e.g., health or legal professionals, social and community support services, etc.)
• information gathered from an interview with the inmate (accredited interpreters must be used when interviewing inmates from non-English speaking backgrounds and inmates who have any difficulty speaking or understanding English, including inmates who are deaf).

Amendments were made in December 2021 to COPP 5.5 Cell Security and Alarm Calls to ensure that prison officers immediately seek medical attention if any doubt arises:

‘The Officer in Charge must immediately alert a Justice Health NSW nurse or NSW Ambulance if the conversation during the alarm call indicates that a serious medical emergency is or may be occurring [indicating medical assistance should be sought where there is doubt]; and a correctional officer cannot immediately attend the inmate’s cell; or a Justice Health NSW nurse is not available in the correctional centre.’

This is further reflected in COPP section 5.5 under subsection 2.2 Cell calls requiring staff to immediately and urgently attend a reported locations, table 1.

An amendment was also made on 11 March 2024, and the following memorandum to staff was issued:

Where the condition of the inmate falls short of the requirement for a medical emergency as outlined in COPP section  13.2 Medical emergencies subsection 1.1 Call for urgent medical assistance, or when a call security and alarm call is received, the circumstances fall short of the requirements to physically attend at a cell in COPP section 5.5 (as above), amendments were made to COPP section  5.5 Cell security and alarm calls and COPP section 3.7 Management of inmates at risk of self-harm or suicide to require all requests for medical assistance to be forwarded to the on-site nurse or on call Nursing Unit Manager (NUM) if there is no medical coverage. See the following extract from the memo:

• All requests for medical assistance are to be forwarded on to the on-site nurse (or on call Nursing Unit Manager (NUM) if there is no medical coverage. The outcome must be recorded (on the new form noted above). Only the initial call from an inmate needs to be recorded to mitigate the need to record the same inmate utilising the cell call alarm multiple times.
•  When inmates in assessment cells physically request to see a nurse or mental health practitioner that it is recorded on the ISP running sheet, a nurse is informed (onsite or via phone) and the results recorded.

When these notifications are made to Justice Health and they have not taken action within 60 minutes, CSNSW Officers are required to follow up with JH. This additional requirement was introduced on 21 May 2024.

Information pertaining to suicide or self-harm risk gathered from family members, friends and other associates of the inmate (e.g., legal or medical professionals) must be taken very seriously.

Justice Health NSW response

Justice Health NSW are supportive of this recommendation, noting action rests with CSNSW. Justice Health NSW documents for information:

• Emergency Response Guidelines
• Policy 1.231 Health Problem Notification Form (Adults)
• Policy 1.331 Referrals from Justice Health NSW to CSNSW
• Procedure 6.129 Patient Enquiry and Self-referral Procedure Manual

Evidence

• COPP section 13.2 Medical Emergencies (PDF, 5.5 MB)
• COPP section 3.07 Managing at Risk Inmates (PDF, 2.3 MB)
• COPP 5.5 Cell Security and Alarm Calls (PDF, 3.3 MB)
• Justice Health Policies