5.3 Case law regarding the provision of medical care in prison Failure to provide adequate medical care in prisons not only raises ethical issues, but may also breach prisoners’ human rights under international law. In examining the question of access to appropriate medical care in prisons and detention centres, some of the following principles have been established. • • • • Prison authorities have an obligation to protect the health of persons deprived of liberty (Hurtado v Switzerland 1994 Series A. No. 280 par. 79) and are required to provide medical assistance and treatment to those held in their custody (Aers v Belgium 1998, Reports 1998-V). This obligation is not dependent on the prisoner’s behaviour: “It must be stressed in this respect that the applicant’s alleged rude behaviour towards medical staff and, indeed, any violation of prison rules and discipline by a detainee, can in no circumstances warrant a refusal to provide medical assistance” (Iorgov v. Bulgaria, 2004 par. 85). Failure to provide appropriate medical care to a prisoner who clearly needs it may amount to inhuman or degrading treatment in breach of Article 3 of the ECHR (Beceiev and Sorban v. Moldova, 2005; McGlinchey v. UK, Application 50390/99 ECHR 2003-V). An increased standard of vigilance is required where a vulnerable person, for example a mentally ill prisoner, is involved, taking into account their vulnerability and their inability, in some cases, to complain coherently or at all about how they are being affected by their conditions of detention (Herczegfalvy v. Austria, 1993 15 EHRR 437). Case study: the death of Mark Keenan85 Mark Keenan was 28 years old when he died from asphyxia caused by hanging in his cell at Exeter prison. His medical history included symptoms of paranoia, aggression, violence and deliberate self-harm. He was previously diagnosed as suffering from paranoid schizophrenia and, from the age of 21, was intermittently treated with anti-psychotic medication. Facts of the case On April 1st 1993 Mark Keenan was convicted of an assault on his girlfriend and sentenced to four months imprisonment. He was admitted to Exeter prison where he was initially placed at the prison’s health centre for observation and assessment. When it was suggested on April 14th that he could be moved to an ordinary location at the prison, he barricaded himself at the health centre in protest. On April 16th he was discharged to ordinary location but was returned to the health centre the following evening after his cell-mate reported that he had made a noose from his bed sheet. He was placed in an unfurnished cell and placed on a 15 minute watch. On April 26th there was another attempt to return him to ordinary location, but he was again returned to the medical centre the following day. On April 29th he was assessed by the prison’s visiting psychiatrist who prescribed a change in his medication, and recommended that he should not associate with other prisoners until his panic subsided. The following day the possibility of movement to ordinary location was raised again. Mark Keenan said that he did not feel fit for the move. In the course of the day his mental state deteriorated, with evidence of aggression and paranoia. The doctor, who Sourcebook on solitary confinement: The role of health professionals in segregation units 65