Corrections Health Service

Complaints Management System in NSW Prisons

Presenters

Leslie Tak

A/Health Planner

Maria Hatzidimitris

A/Client Liaison & Policy Officer

Session Outline

Context - Complaints in the NSW Correctional System

– Health Services– Demographics– Constraints

Complaints Management System– Flow Chart– Statistics– Case Study– Quality Activities– Future Directions

Is a statutory corporation that provides a wide range of health services across NSW:

– 29 correctional centres

– 10 detention centres and

– 6 court/cell police complexes

Corrections Health Service

Health Services Provided by CHS

• Mental Health• Primary Health• Public Health• Drug & Alcohol• Clinical Services

Oral Health Physiotherapy Art Therapy Occupational Therapy

Radiology

Inmate Profile

Inmates have a substantially lower socio-economic

status than in other communities (Essential Equity)

As socio-economic status is a powerful predictor

of health status, this fact also has implications for

Corrections Health Service

Inmate Population The full time inmate population is projected to

increase from 7,300 in 1998/99 to 9,500 in 2008/09

Predominantly young males, with a shift toward older inmates and increase in females inmate numbers.

71% Australian born and 16% born overseas in a non English speaking country

Approximately 16% Aboriginal and Torres Strait Islander

Inmate Health Status: General Trends

80% of inmates have been incarcerated for offences related to drug and alcohol use

Some 60% of males and 70% of females have a history of illicit drug use.

Around one third of the males and two third of females are hepatitis C positive

Approximately one third of males and half of females have been assessed or treated for mental illness

Constraints Impacting Health Delivery

16,000 annual receptions

Length of Stay– 27% less than 8 days– 17% between 8 and 30 days– 56% greater than 30 days

Movements– 7,500 escorts to court per month– 127,000 internal movements per year

Constraints cont.

• Corrections Health Service as separate from Department of Corrective Services

• Access • Security issues supersede health issues • Language barriers • Cultural barriers • Expectations of health services may be

unrealistic or non-existent.• Public Opinion re Inmates & Health Service

Complaints Management

Corrections Health Service has a strong

commitment to improving the health of people

in the NSW correctional system

Complaints Management is an integral part

of the quality monitoring and improvement

cycle

Complaints Management - Review

1998 CHS conducted a formal review :

NSW Better Practice Guidelines for Frontline Complaints Handling

NSW Ombudsman’s Effective Complaint Handling Guidelines Statewide Complaints Data Collection Better Health Good Health Care

Complaints Management System

• Flow Chart: Path flow for complaint process

• Statistics: <3% of the inmate population have lodged a complaint

18% of these unsubstantiated

• Case Study: Symptoms

Investigation

Outcome

• Quality Activities

• Future Directions

Source 3%

1%

6%

5%

5%

2%

0%

1%

11%

4%

4%8%

Direct from complainant

50%

CHS Staff

Commonwealth GovernmentDepartmentDepartment of CorrectiveServicesDirect from complainant

Health Care ComplaintsCommission (HCCC)Legal

Member of Parliament

Multiple of Above

NSW Department of Health

NSW Ombudsman

Official Visitor

Other State GovernmentDepartmentRelative

Issues 4% 3%3%

11%

5%

4%

8%

14%6%

7%

6%

3%

5%

21%

Administrative Services

Attitude

Coordination of Treatment

Delay in Admission ortreatmentDischarge or TransferArrangementsInadequate Treatment

Inadequate/No response tocomplaintMedication*

Referral

Refusal to Admit or Treat

Resources/ServiceAvailabilityTransport

Wrong/InappropriateTreatmentOthers

Case Study - BackgroundComplaint to Official VisitorSymptoms:

Shortness of BreathSwollen joints & limbsSkin rashPins & needlesWeakness & muscle fatigueSymptoms of arthritis Sharp pains in lower chest

Case Study – Investigation Outcomes Referred to hospital Missed five appointments High level security required for external

medical appointments Appointments cancelled due to lack of staffing Prescribed anti-inflammatory and analgesics Referred to hospital after symptoms persisted

Case Study – Investigation Outcomes

Venous Ultrasound negative & diagnosed with cellulitis

Commenced on antibiotics Symptoms temporarily reduced Security measures improved & referred back to

hospital Diagnosed with pleural effusion & anaemia During admission diagnosed with SLE

Key Issues

1. Diagnosis

2. Inadequate Treatment

3. Wrong/Inappropriate Treatment

4. Negligent Treatment

Summary of Investigation Outcomes

Delays in diagnosis due to environmental

constraints

DCS and CHS believed to be one

organisation

Mr X reluctant to seek medical attention after

hours

Resolution Mechanism

Resolution process initiated

Mr X satisfied with the treatment provided

Enhanced communication

Promotion of CHS as a separate entity

Quality Activities from Investigation

Clinic hours reviewed to address needs of

working inmates

In-service for CHS staff relating to the impact

of security measures

Promotion of CHS (via posters, brochures,

video)

CHS Quality Activities

External Audit of Complaints Management System

Reports to Quality Council, CHS Board, Clinics across the State, NSW DOH

Specialty reports Complainants’ Satisfaction Survey Education Sessions Consultation with Consumers, Consumer and

Community Representatives

Inmate Health Survey 2001 Encourage inmates to view complaint as

a positive partnership and as constructive measure for improvement

Promotion of the Service as separate to the Department of Corrective Services

Multilingual Patient Information Brochure

Posters for inmates on how to lodge a complaint

CHS Future Directions