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Medical Legal Experts Working in Prisons 2018 - Dr Mark Burgin

18/12/18. Dr Mark Burgin BM BCh (oxon) MRCGP explains the pitfalls that can occur when performing a Prison Visit for medical legal purposes and the problems arising from increasingly restricted availability of private areas for examinations.

Every prison has its own system so that doctors need to arrive half an hour prior to the appointment to ensure that they can make enquires and follow all the necessary steps.

Doctors must obey the rules, subject themselves to searches, answer questions and follow orders from the prison staff but are not protected under any special regulations.

Doctors retain their duty under the GMC guidance and the Human Rights Act article 3 to ensure that the prisoner is not subject to degrading or inhuman experience. (1)

There are increasing reports of doctors left confused about what to do if they are refused permission to examine or forced to examine prisoners in settings where there is no privacy.

Complaints about the treatment of the doctor or the prison treatment of the prisoner should be made in writing to the governor or inspector of prisons after exit from the prison.

Entry process

There are typically a list of banned articles including chewing gum, cigarettes, smart watches, mobile phones and money with a value greater than £10.

Additionally some prisons will also prohibit carrying any photographic ID, car keys, combs, belt, tissues, wrist watch and provide a locker (needs one pound) to store them.

Photographic ID (Passport and photo driving licence) is always required and a letter of instruction on headed note paper and business card are often necessary.

The search process can include x-ray scanner, metal detector, passive and active (dog) drug detection, airport style rub down and finger print and facial photography.

Refusal of entry can occur if the prison is in lock down, the prisoner has been moved (this occurs without notice for security reasons) or the booking process has been unsuccessful.

Interacting with staff

Once approved to enter a prison the doctor is escorted through the prison and may need to show a paper wrist band provided by the prison or undergo biometric checks.

The doctor should maintain a quiet professional manner and promptly follow the prison officer’s orders and should not use any humour as this can be easily misinterpreted.

If the doctor requires anything they should politely request and be prepared to accept refusal however unreasonable that refusal appears.

I recommend using Sir or Ma’am when addressing a prison officer, speaking quietly, keeping your hands by your side and sitting down when possible.

Prison officers are taught to escalate a doctor’s request asking for advice on the telephone, taking the doctor to separate room and standing within the doctor’s comfort zone.

Visits in Healthcare or Legal Visits areas

Most prison healthcare departments refuse to allow doctors to examine prisoners for medicolegal purposes although they may not realise that they can charge for this purpose.

The legal visits area is typically a large open room filled with tables and with a desk in the corner where officers sit who allocate a table for the prisoner and doctor.

There are usually separate rooms which have large windows which are unsuitable for anything but the most minor examination of for example facial scarring.

Some prisons have started to refuse to allow any medical legal examinations to occur in legal visits even where there is no requirement to remove clothing.

Do not proceed with an examination if it requires removing of shirt or trousers in a room with windows or the prisoner does not consent.

Conclusions

It is understandable that the medical expert visiting prisoners to perform medical legal examinations may be concerned about their own safety and feel they must decline this work.

Good preparation is key to a successful visit with liaison with the visits service about the prison’s systems and ensuring that the doctor is not carrying any banned items.

When interacting with prison staff, recognise that they may as frustrated with unreasonable rules as the doctor and that they are unable to back down once they have made a decision.

Do not raise issues whilst in prison as this can lead to an escalation of the prison officer’s responses and they are unable to deal with issues once the doctor has entered the prison.

Access to justice (2) is for the Prison Governor or the Home Office to resolve and the doctor should refuse to perform any examination that could conflict with a prisoner’s human rights.

Human Rights Act 1998

    1. Article 3 Prohibition of torture - No one shall be subjected to torture or to inhuman or degrading treatment of punishment

    2. Article 6 Right to a fair trial. 3 (b) to have adequate time and facilities for the preparation of his defence.

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