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| Police said HN was 'good as gold' to be in custody, three days later he was dead | Police said HN was 'good as gold' to be in custody, three days later he was dead |
| (4 months later) | |
| On 30 December 2008 a 24-year-old Aboriginal man from the remote community of Balgo died in the Royal Perth hospital, three days after being bashed under the security cameras of a service station in Broome. | On 30 December 2008 a 24-year-old Aboriginal man from the remote community of Balgo died in the Royal Perth hospital, three days after being bashed under the security cameras of a service station in Broome. |
| The man, referred to as HN, was still unconscious when police arrived and arrested both his brother and the man who had attacked them. When HN regained consciousness, they arrested him too. | The man, referred to as HN, was still unconscious when police arrived and arrested both his brother and the man who had attacked them. When HN regained consciousness, they arrested him too. |
| He was taken to Broome hospital where he was checked but did not receive a brain scan from a doctor who falsely believed the assault had taken place two hours earlier. An autopsy later revealed extensive skull fractures and intracranial haemorrhaging. | He was taken to Broome hospital where he was checked but did not receive a brain scan from a doctor who falsely believed the assault had taken place two hours earlier. An autopsy later revealed extensive skull fractures and intracranial haemorrhaging. |
| He left the hospital against medical advice and was arrested again by a police officer who thought he were “good as gold” to be held in custody. Information recorded on the medical intake form at Broome watch house was incomplete or incorrect. | He left the hospital against medical advice and was arrested again by a police officer who thought he were “good as gold” to be held in custody. Information recorded on the medical intake form at Broome watch house was incomplete or incorrect. |
| Six hours later, HN was found unresponsive in his cell. Former state coroner Alastair Hope said his care and supervision was “suboptimal”. | Six hours later, HN was found unresponsive in his cell. Former state coroner Alastair Hope said his care and supervision was “suboptimal”. |
| “It is most unfortunate that the deceased was an innocent man who died in police custody,” Hope said. | “It is most unfortunate that the deceased was an innocent man who died in police custody,” Hope said. |
| HN is one of 147 Aboriginal and Torres Strait Islander people to die in custody in Australia since 2008, according to an investigation by Guardian Australia. | HN is one of 147 Aboriginal and Torres Strait Islander people to die in custody in Australia since 2008, according to an investigation by Guardian Australia. |
| He is also one of 45 Indigenous people who did not receive all appropriate health care in custody and one of 47 who died in circumstances where the government agency responsible for his care – in this case the police – did not follow all their own procedures. | He is also one of 45 Indigenous people who did not receive all appropriate health care in custody and one of 47 who died in circumstances where the government agency responsible for his care – in this case the police – did not follow all their own procedures. |
| Deaths inside: every Indigenous death in custody since 2008 tracked – interactive | |
| Six years after HN’s death, Yamatji woman Ms Dhu died in similar circumstances after being detained in the South Hedland watch house for unpaid fines. Like HN, she died not from injuries sustained in hospital but from complications following a prior assault, in circumstances where doctors failed to perform tests which may have identified her life-threatening condition. | Six years after HN’s death, Yamatji woman Ms Dhu died in similar circumstances after being detained in the South Hedland watch house for unpaid fines. Like HN, she died not from injuries sustained in hospital but from complications following a prior assault, in circumstances where doctors failed to perform tests which may have identified her life-threatening condition. |
| Dr Sandra Thompson is a specialist in rural and Aboriginal health and was an expert medical witness on the Dhu inquest. She said that institutionalised racism played a role in her death, telling the inquest in 2015: “I think if that had been a white, middle-class person, there would have been a lot more effort made to come to the cause of the pain.” | Dr Sandra Thompson is a specialist in rural and Aboriginal health and was an expert medical witness on the Dhu inquest. She said that institutionalised racism played a role in her death, telling the inquest in 2015: “I think if that had been a white, middle-class person, there would have been a lot more effort made to come to the cause of the pain.” |
| Medical issues have been the leading cause of death for both Indigenous and non-Indigenous people in custody since 2001. In coronial reports, such deaths are attributed to “natural causes”. It’s a broad term, that covers everything from the untreated abscesses and septicemia suffered by Dhu to terminal cancer. | Medical issues have been the leading cause of death for both Indigenous and non-Indigenous people in custody since 2001. In coronial reports, such deaths are attributed to “natural causes”. It’s a broad term, that covers everything from the untreated abscesses and septicemia suffered by Dhu to terminal cancer. |
| Analysis conducted by Guardian Australia found that 48% of the Indigenous deaths in custody in the past decade were attributed to “natural causes”. | Analysis conducted by Guardian Australia found that 48% of the Indigenous deaths in custody in the past decade were attributed to “natural causes”. |
| In almost a third of those cases the deceased person did not receive all appropriate medical care. | In almost a third of those cases the deceased person did not receive all appropriate medical care. |
| Indigenous people who died of medical issues were also a decade younger than their non-Indigenous counterparts, dying at an average age of 48. | Indigenous people who died of medical issues were also a decade younger than their non-Indigenous counterparts, dying at an average age of 48. |
| Ms Dhu inquest: doctors 'would have made a lot more effort’ if she was white | |
| Thompson said the quality of healthcare in custodial environments was often affected by a lack of cultural competency on behalf of corrections or medical staff, a lack of health literacy on behalf of the people being detained, and an inability to gather what was often a very complex medical history. | Thompson said the quality of healthcare in custodial environments was often affected by a lack of cultural competency on behalf of corrections or medical staff, a lack of health literacy on behalf of the people being detained, and an inability to gather what was often a very complex medical history. |
| If they do need medical care, Thompson said, a prisoner has to convince several gatekeepers, from a prison officer to a supervisor to a prison nurse, before being granted access to see a doctor or go to hospital. | If they do need medical care, Thompson said, a prisoner has to convince several gatekeepers, from a prison officer to a supervisor to a prison nurse, before being granted access to see a doctor or go to hospital. |
| “There’s that sort of suspicion that goes with someone where they’re in the custodial setting,” she said. “They don’t see them as patients. They probably just see them as people who are being difficult and causing more of a fuss than they should.” | “There’s that sort of suspicion that goes with someone where they’re in the custodial setting,” she said. “They don’t see them as patients. They probably just see them as people who are being difficult and causing more of a fuss than they should.” |
| If a hospital visit or specialist medical appointment is needed, protocols requiring at least two prison or police officers to accompany a detained person to hospital mean that visit could be delayed, postponed or aborted due to staff shortages or prison lockdowns. | If a hospital visit or specialist medical appointment is needed, protocols requiring at least two prison or police officers to accompany a detained person to hospital mean that visit could be delayed, postponed or aborted due to staff shortages or prison lockdowns. |
| It’s a scenario that Dr Anthea Krieg saw frequently as clinical director of the South Australian prison health service. Kreig held the role from 1998 to 2001 and and still works in Aboriginal health and youth justice. | It’s a scenario that Dr Anthea Krieg saw frequently as clinical director of the South Australian prison health service. Kreig held the role from 1998 to 2001 and and still works in Aboriginal health and youth justice. |
| “That’s part of the routine, that there’ll be a lock down and something won’t happen,” she said. “You go the to follow up with people and you’ll find out that they’ve been transferred to a regional centre ... there hasn’t been time to even advocate with the prison to say: hey, this person needs to stay tight. | “That’s part of the routine, that there’ll be a lock down and something won’t happen,” she said. “You go the to follow up with people and you’ll find out that they’ve been transferred to a regional centre ... there hasn’t been time to even advocate with the prison to say: hey, this person needs to stay tight. |
| “Security would always trump [health concerns].” | “Security would always trump [health concerns].” |
| Inter-prison transfers also saw some medical records lost. DN and AT both died at WA’s Greenough Regional Prison after doctors at other prisons had flagged the need for specialist tests. In DN’s case, he had seen a cardiologist but that information was not made available in his prison medical file. The WA department of corrective services has since moved to a specialist electronic medical records system. | Inter-prison transfers also saw some medical records lost. DN and AT both died at WA’s Greenough Regional Prison after doctors at other prisons had flagged the need for specialist tests. In DN’s case, he had seen a cardiologist but that information was not made available in his prison medical file. The WA department of corrective services has since moved to a specialist electronic medical records system. |
| Health services within prisons are funded through state budgets rather than through Medicare, which makes it difficult for external medical services, such as Aboriginal community-controlled health services, to run in-reach programs. | Health services within prisons are funded through state budgets rather than through Medicare, which makes it difficult for external medical services, such as Aboriginal community-controlled health services, to run in-reach programs. |
| “Most of us who have worked within prison health services and Aboriginal health services see the need for an in-reach model, but it just doesn’t happen,” Krieg said. | “Most of us who have worked within prison health services and Aboriginal health services see the need for an in-reach model, but it just doesn’t happen,” Krieg said. |
| She said that health services in a prison ought to be of the same standard provided in the community, “and the way to do that would be through a Medicare-based system”. | She said that health services in a prison ought to be of the same standard provided in the community, “and the way to do that would be through a Medicare-based system”. |
| “I think the net effect [of not having Medicare in prison] is that less does get done and there’s a paring back of service provision,” Krieg said. “There’s not a sense really of offering that full range of services.” | “I think the net effect [of not having Medicare in prison] is that less does get done and there’s a paring back of service provision,” Krieg said. “There’s not a sense really of offering that full range of services.” |
| The Australian Medical Association wrote to health minister Greg Hunt in 2017 arguing for the expansion of Medicare into prisons, saying there was “growing evidence that states and territories are not providing in-prison health services in a manner equivalent to that available in the community”. Hunt said he had no intention of changing the current arrangement. | The Australian Medical Association wrote to health minister Greg Hunt in 2017 arguing for the expansion of Medicare into prisons, saying there was “growing evidence that states and territories are not providing in-prison health services in a manner equivalent to that available in the community”. Hunt said he had no intention of changing the current arrangement. |
| Darkinjung woman Aunty Kerrie Doyle is an associate professor of Indigenous health at RMIT University, but spent part of her career in the 1990s working as a registered nurse in the New South Wales prison system. | Darkinjung woman Aunty Kerrie Doyle is an associate professor of Indigenous health at RMIT University, but spent part of her career in the 1990s working as a registered nurse in the New South Wales prison system. |
| She said improving medical care in for Indigenous people in prisons was a “wicked problem”, made even more difficult by “the embedding of negative stereotypes”. | She said improving medical care in for Indigenous people in prisons was a “wicked problem”, made even more difficult by “the embedding of negative stereotypes”. |
| Doyle said differences of language fed those stereotypes and created a perception on behalf of doctors that some Indigenous patients were “difficult”. | Doyle said differences of language fed those stereotypes and created a perception on behalf of doctors that some Indigenous patients were “difficult”. |
| “Even when you’re talking to somebody who speaks English as good as Trump would expect there’s still issues around language,” she said. “Swearing is common in Aboriginal communities and yet people choose to be offended when they hear those words. For people who may be having difficulty expressing how distressed they are, they might use some cuss words, then people are going to arc up at them, they are hardly going to continue to communicate their distress.” | “Even when you’re talking to somebody who speaks English as good as Trump would expect there’s still issues around language,” she said. “Swearing is common in Aboriginal communities and yet people choose to be offended when they hear those words. For people who may be having difficulty expressing how distressed they are, they might use some cuss words, then people are going to arc up at them, they are hardly going to continue to communicate their distress.” |
| Families of those who died in custody frequently told coroners’ courts that they were not told they had been moved from prison to hospital and often learned of their loved one’s death before being formally notified by police. | Families of those who died in custody frequently told coroners’ courts that they were not told they had been moved from prison to hospital and often learned of their loved one’s death before being formally notified by police. |
| Those in hospital were usually shackled to the bed even when they were to ill to move, and in some cases after they had slipped into a coma. | Those in hospital were usually shackled to the bed even when they were to ill to move, and in some cases after they had slipped into a coma. |
| Prison policies across Australia state that a person must be restrained while outside of prison grounds, but also give senior officers the discretion to remove restraints in circumstances where they are unnecessary or inhumane. Coroners found that discretion was not often used. | Prison policies across Australia state that a person must be restrained while outside of prison grounds, but also give senior officers the discretion to remove restraints in circumstances where they are unnecessary or inhumane. Coroners found that discretion was not often used. |
| Doyle said that issues of consent for medical procedures, notifying next of kin and managing end of life care had to be considered through a cultural lens. | Doyle said that issues of consent for medical procedures, notifying next of kin and managing end of life care had to be considered through a cultural lens. |
| “You can’t just squash a non-Indigenous model in and expect that Indigenous people will work with it because they just won’t,” she said. | “You can’t just squash a non-Indigenous model in and expect that Indigenous people will work with it because they just won’t,” she said. |
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