Appendix 4Casuarina Prison visit (Casuarina, Western Australia)
Introduction
1.1On Tuesday 15 August 2023, the committee visited Casuarina Prison in Perth, Western Australia, to tour its health centre and dental facilities.
1.2Casuarina Prison is the main maximum-security prison for Western Australia, located in the suburb of Casuarina. The prison accommodates minimum-, medium- and maximum-security prisoners. It was opened in 1991 to replace Fremantle Prison, which was 130 years old. Casuarina Prison holds approximately 1200 male prisoners.
1.3The committee would like to thank West Australian Minister for Corrective Services, the Hon Paul Papalia CSC MLA, for authorising the visit, along with West Australian Commissioner for Corrective Services,MikeReynolds, and Casuarina Prison Superintendent, Jim Schilo, for arranging the tour of the prison’s health centre and dental facilities. In addition, the committee thanks Director Health Services, MrDave Whittle, and the Department of Justice (DoJ), for assisting with the visit.
1.4Finally, the committee would like to acknowledge the staff and inmates at the prison and thank them for accommodating the committee’s visit, and generously answering the committee’s questions.
Dental services at Casuarina Prison
1.5The committee were taken on an inspection of the prison’s health centre and dental facilities and provided with an overview of the prison facility which is summarised below.
Responsibility
1.6In Western Australia, the DoJ is responsible for the welfare and safe custody of all prisoners, as outlined in the PrisonsAct1981(WA). Health services in the prison are the responsibility of DoJ, with dental services provided through a Memorandum of Understanding (MOU) between DoJ and the North Metropolitan Health Service (NMHS), a division of the West Australian Department of Health Services (DHS).
1.7The MOU was signed in 2020 and operates until June2024, when it is due to be reviewed. The MOU covers dental service provision in a number of prisons, including Casuarina. Under the MOU, DHS operates dental clinics at the prisons, using prison facilities.
1.8Eligibility for services, safety considerations for staff, and priority lists for treatment are determined by DoJ, rather than DHS staff. The clinic service at Casuarina does not operate with pre-booked appointments. Rather, patient lists are provided by prison officials to the health services staff, and prisoners are brought in for treatment in an order determined by prison officials.
1.9DoJ is responsible for providing the dental instruments and equipment, and funding consumables. DHS is responsible for maintaining and testing equipment, and invoices DoJ for this activity.
1.10The prison provides basic oral hygiene products to inmates, including toothbrushes and toothpaste. Inmates can buy dental floss but mouthwash is not available.
1.11DHS provides quarterly patient activity reports to DoJ which provide statistics on services and treatments provided. Patient records are managed and stored collectively by both DHS and DoJ.
1.12The MOU states that the provision of dental services by DHS within the relevant prisons is dependent on DHS having the available budget and staffing in each financial year during the term of this MOU. The committee was told that funding for dental health services has not increased in five years, despite prison populations increasing between 5 and 10 per cent year on year.
Dental services
1.13At Casuarina, the dental clinic currently runs three days per week and is contracted to provide:
Oral health advice and preventive care
Emergency dental care
General routine dental care (e.g. cleaning, fillings and extractions), and
Referral to other services for specialist dental care.
1.14The service does not provide root canal treatment or crowns. Inmates with dentures may have them repaired, and long-term residents of the prison may go on a waitlist to be fitted with dentures.
1.15To be considered for treatment, inmates generally self-refer by filling out a form. For those with literacy issues, peer support workers are available to assist patients to fill out the form.
1.16While the MOU provides for preventative and routine care, a majority of the service provided is emergency care. Patients who are febrile or in acute pain are prioritised, and routine care is often deferred.
1.17When it is operating, the dental clinic is staffed by one dentist and one dental assistant. On a ‘good day’ the service may see 10 patients. However, how many patients are seen in a day is highly dependent on the availability of guards to escort prisoners, and on other things going on in the prison that day.
1.18As at 15August 2023, the waitlist included 347 people.
1.19Health services staff were able to confirm reports that prisoners have pulled out their own teeth while waiting for treatment, particularly in cases where the tooth is already loose.
1.20Health services staff reported that, during a two-month period in 2022, there was no dental service at all.
1.21Securing staff to work in both the health centre and dental service can be challenging. Staff who work in the health centre are employed by DoJ—rather than DHS—which is a disadvantage, as DoJ staff do not have the same access to salary sacrifice provisions that health and community services staff have.
Facilities
1.22The committee was able to tour the health centre at Casuarina Prison, including the dental clinic area. Officials noted that the health precinct was opened in 1991 and has not been renovated since. The health centre includes a high-needs area and mental health unit. The building has no heating or cooling, so staff and inmates endure high temperatures in summer, and the cold in winter.
1.23The dental clinic is operated in a single room, which also doubles as an office for the nutritionist when the clinic is not active. The room does not appear purpose-built as a dental clinic. It has one dental chair.
Challenges and limitations
1.24The committee heard that health services staff at Casuarina do ‘the best they can’ with very limited resources.
1.25Almost 60 per cent of inmates at Casuarina are on remand and the other 40percent have been sentenced. Approximately 45 per cent of inmates are Aboriginal or Torres Strait Islanders. With very limited resources, health centre and prison staff generally prioritise treating longer-term prisoners over those on remand—who may be released into the community or moved to another prison. The health and dental services are also prioritised by urgency.
1.26The committee heard that the prison houses 21 inmates over the age of 70 and some of these elderly prisoners live full-time in the health centre. There are also 30prisoners with terminal illness.
1.27Many inmates come into the prison with very poor oral health, especially those impacted by drug addiction and alcohol abuse. A large proportion of prisoners have mental health disorders, and/or intellectual disabilities, making treatment much more difficult.
1.28Managing pain is a constant challenge for health and dental service staff, who have to carefully control the use of medications and identify drug-seeking behaviours. Dental pain is often managed with Tramadol and antibiotics, along with paracetamol.
1.29When high-risk prisoners need dental care, the security considerations are more complex. This can lead to lost clinic time and fewer patients being seen during the dentist’s visit.
1.30The committee heard that prison inmates are not eligible for funding under Medicare for the duration of the time they are in prison. This means DoJ must pay for everything—from medications and equipment, to hospital transfers and treatment.
1.31Interestingly, this same policy does not apply to the National Disability Insurance Scheme (NDIS). Prisoners who have an NDIS plan may continue to receive supports while in custody, and inmates with disabilities can (at least theoretically) apply for the NDIS while in prison.
Future directions
1.32Prison officials told the committee that DoJ is preparing to go out to tender for a new provider of health services, and has plans to build new facilities from 2026.