Doctor: detainee healthcare ‘unsafe’ and ‘alarming’
A doctor told an inquest jury yesterday how the healthcare department at a detention centre was so unsafe that she stopped working there.
Dr Farrah Jarral told the jury at West London Coroner’s court that she had worked as a locum GP at Harmondsworth immigration removal centre (a stone’s throw from Heathrow Airport) in January 2013.
Harmondsworth’s healthcare wing, run by private medical company Primecare, was “extremely basic, staffing wise and facility wise”, said Dr Jarral. She witnessed several “alarming” incidents. “It feels like a prison,” she said.
Dr Jarral was particularly concerned when she saw 84 year old Alois Dvorzak in the detention centre on 30 January 2013. She warned the Home Office that it was “entirely inappropriate for an elderly frail man like that to be in detention”.
Dvorzak died on 10 February 2013. When Dr Jarral read about his death in the media, she was “devastated”.
Alois Dvorzak had been travelling from Canada to visit his daughter to Slovenia. He stopped over in London, where immigration officers refused him entry and were concerned about his health. They took him to East Surrey Hospital where doctors said he was fit enough to be repatriated. The Home Office put Dvorzak in Harmondsworth detention centre, run by the Geo Group, until a flight back to Canada could be arranged.
Nursing staff at Harmondsworth told Dr Jarral that they “were very concerned about a frail man who had dementia”.
She was “very surprised” that East Surrey had assessed him as “fit to fly”.
East Surrey Hospital had obtained a list of Dvorzak’s medication from his care home in Canada. He was on at least 13 different drugs, including olanzapine, citalopram, and lorazepam.
Dr Jarral said that this “significant information” about Dvorzak’s health “was not available to me at the time”.
Senior Coroner Chinyere Inyama asked Dr Jarral: “When you see medication prescribed like that does this indicate a major mental illness?”
Dr Jarral replied: “Absolutely.”
The coroner asked Dr Jarral what she would have thought had she known that Dvorzak was taking those medicines.
The doctor replied: “I would have been worried if he had self capacity to make decisions. He was on a major tranquilliser and anti-depressant …There should have been a full mental health assessment by a psychiatric doctor, not by nursing staff. For a patient to be on a combination of these three drugs would indicate significant mental health concerns.”
Dvorzak had also been prescribed blood thinners. Dr Jarral said that would have been “relevant to a patient who had previous heart failure or a stroke”.
Dr Jarral told the jury: “When I went to see him he was lying on a bed and was very withdrawn. He was very frail. He had a blank facial expression that’s common with dementia. … Having established that this patient was not talking much and was very frail it was clear to me that this man was not suitable to be in detention.”
She was told to fill out a form alerting the Home Office that Dvorzak was not suitable for detention. Jarral completed and submitted the form, called a Rule 35 report, but she had little confidence in the reporting system.
“I thought the piece of paper . . . was going to get lost,” she said. “It was not a system I could feel confident in. I wanted to speak to a person.”
She relayed her concerns to a Home Office worker and reiterated that it was “really inappropriate for him to be in detention”.
Dr Jarral asked if any attempts had been made to contact his family. She said the Home Office told her that they “could not confirm or deny if this had happened and said it was none of our business”.
(The jury has heard from other witnesses that more medical information about Alois Dvorzak had already been obtained from healthcare workers in Canada and the Home Office was in contact with the Canadian authorities.)
Dr Jarral was told to fill out more paperwork. She did that, and “documented in medical notes that I felt he was unsuitable for detention”.
After leaving Harmondsworth on 30 January 2013 Dr Jarral was still “so concerned”.
Having received an email from an NGO worker with whom she had raised her concerns, she decided to call the Canadian High Commission.
She told the jury that at the time she had been very worried about breaking patient confidentiality but “in hindsight I could have gone further”.
She said diplomatic staff recorded her concerns that a Canadian citizen in Harmondsworth was “vulnerable and very at risk”.
“The next thing I knew was an article in the Guardian reporting his death. I was devastated,” Dr Jarral said.
Dr Jarral told the jury that she “went into that situation with very little information” because facts about Dvorzak’s health had not been given to her, or there were “some major factual inaccuracies” in the Home Office’s emails.
“There were occasions where it seems the message has completely been lost. There was no mention of mental health even though he had been on these drugs.”
Dr Jarral said it was “worrying” that the Home Office were “cutting off medical information from doctors”. She said this was “not a safe way to practice”.
She said she had been made to feel “silly calling the Canadian High Commission when they were fully aware” of Dvorzak’s predicament.
Dr Jarral said she already had concerns from previous visits. She told the jury:
“There where a few incidents that alarmed me about healthcare at Harmondsworth. It was not really set up for delivering healthcare. It was very sparsely equipped and staffed.”
She was scathing about the absence of electronic medical records and recalled how she was given paper notes that may have a name misspelt.
It was not possible to get rapid test results like it was in a hospital, even though detained patients might be on medicines such as anticoagulants, whose use requires careful monitoring.
The doctors were often locums, agency staff who turned up for a day and then went away, Dr Jarral said.
The coroner asked her what training new doctors were given at Harmondsworth.
Dr Jarral replied: “I was given brief verbal sign posting. This is pretty concerning. In a situation where people are in prison or detention there are higher incidents of mental health and trauma. Doctors need training because there are issues that are more in focus than outside and accidents could lead to someone being harmed.”
She had particular concerns about the reporting process that is supposed to keep people safe. Rule 35 of the Detention Centre Rules (a statutory instrument) requires doctors working in detention centres to inform the Home Office about detainees who have experienced torture before coming to the UK or who are otherwise unfit to detain. Officials are required to consider this information and release the person.
Dr Jarral said that there were “very huge consequences” when doctors failed to submit adequate Rule 35 medical reports. She said: “The consequences of not filling that in properly could be people sent back to their country and killed, if you hadn’t had that training and experience to detect serious torture.”
Dr Jarral, who had worked at other custodial facilities, including Wormwood Scrubs prison, said she decided that it “was not safe to continue at Harmondsworth because my actions could lead to someone being harmed”.
Mr Hilton, representing the Home Office, reminded Dr Jarral that the jury had been told that East Surrey Hospital staff found Dvorzak “stable. Fit to be released from our care. Does not need medication from us. Has capacity to make decisions”.
Dr Jarral replied: “I have much doubt that he would have had capacity. He said there were ‘demons tormenting him’.”
She said: “He needed to be on an elderly care ward for several weeks.”
Hilton asked if that was “not a viable option because he was not a UK citizen?”
Dr Jarral said non-citizens could be admitted to acute emergency care. She said doctors at Harmondsworth needed more training because it can be “critical to someone’s life”.