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Being a General Practitioner in the Prison Environment

Special Reports

by Dr James Jesse Hard, General Practitioner MBBS FRCGP

Some of the most interesting, challenging and complex medicine I have faced in my near 10-year career as a GP has been behind a five meter-high wall; caring for those that have been remanded or sentenced in our criminal Justice system.

Being able to focus on the doctor-patient relationship is the key skill. By overstepping any pre-judgement and striving to deliver medical care without compromising my own integrity or sacrificing my ethical principles is the way I practice.

Everyone here is someone’s son or daughter; they weren’t always in prison and many, will eventually be released into our wider community. So, for me, the objective is in engagement with individuals before me - with aim of making a difference to their lives.

Since 2006, General practitioners have been the doctors responsible for delivering health care in prisons and the principle of “equivalence” drives the ever-improvement of standards of care inside their walls.

Being an Expert Witness in the Prison Environment
With nearly ten years experience of prison General Practice experience, including some time spent as a clinical lead in one establishment, I have gained a wealth of experience with the men, women and children in the public and private sector prisons in England and Wales.

I am passionate about prison medicine and just as passionate about supporting both the clinicians and patients where expertise is required to guide the courts in civil claims. I have nearly four years of experience as an expert in this setting and have built a portfolio of around 30 (clinical negligence) cases during this time.

Being able to fully appreciate the unique context of prison healthcare is fundamental to being able to guide the court in these matters. On many occasions, Claims may appear straightforward. Close inspection of the medical records by a Prison GP, provides a more faithful perspective of the care being provided than when viewed by the untrained eye.

A common example is where a Claim arises out of medication being stopped abruptly. In the community general practice setting this may appear to be negligent. However, in the prison setting, medication is often seen as a currency item for misuse and diversion and many of these drugs can be sought from the prison GPs for these reasons. The consequences of this ‘diversion’ can range from addiction, overdose and death to bullying and violence.

Another example is where the care provided to an inmate falls outside of the boundaries of so-called “equivalent” care. An example case: an injured leg, why was a scan not undertaken as it would have been had the patient been in his community GP surgery? The medical records in this case reveal a rushed consultation, little in the way of history or examination is recorded. This is not defensible practice.

Expert Witness work cross-pollinates into other aspects of the highly-inspected prison environment. So, being able to provide a critical clinical eye on Death in Custody reviews, the Coroner or the Parliamentary and Health Service Ombudsman serve to provide these bodies with the expertise necessary to fully support their investigations with that ‘inside’ knowledge. Being able to decipher and read between the lines of the prison clinical system can yield a detailed view into the care being provided and this helps provide inspectors and commissioners with a better understanding of areas for improvement.

Dr James Jesse Hard
Tel: 07930 367467
Mob: 07930 367 467
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Dr James Jesse Hard is a GP with special interests in prison medicine and substance misuse. He is an Associate Clinical Advisor to the Parliamentary and Health Service Ombudman and has assisted in cases pertaining to prisons, in and out-of-hours general practice as well as substance misuse cases. Dr Hard
is also a Clinical Reviewer for Death in Custody reviews for the Prison and Probation Ombudsman and NHS England

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