Report of the Inquiry into the circumstances of the Death of Bernard ...

Chapter 13:
ISSUES RAISED IN THE CLINICAL REVIEW (2): ASSESSING PRISONERS’
FITNESS FOR ADJUDICATION AND CELLULAR CONFINEMENT
Introduction
13.1 In his clinical advice to the inquiry, Dr Wright argued that there was a systems
failure in the process of assessment for fitness for adjudication and cellular confinement.
He commented on the need for care and assessment to be based on consistent
therapeutic relationships. This chapter sets out Dr Wright’s advice and describes current
Prison Service policies and the system operating now in the segregation unit at
Manchester prison.
The medical officer’s assessment of Sonny Lodge’s fitness
13.2 Before the adjudication on 28 August, Mr Lodge was seen by the prison medical
officer who was required to assess whether he was fit for adjudication and fit for cellular
confinement, in case the adjudicator wanted to impose cellular confinement as a
punishment. The medical officer told the Prison Service investigation that he did not
know Sonny Lodge nor see his medical or prison record and that he assessed his fitness
on the basis of an examination of his mood at the time, not his history.
Dr Wright’s advice
13.3 Dr Wright advised that in 1998 a clinician faced with a request to certify fitness for
adjudication and cellular confinement would in all probability do so unless the patient
was an inpatient in a hospital wing. However he considered this unsatisfactory.
13.4 Dr Wright noted underlying problems with the system. Asking a doctor to make
an assessment for a purpose other than a therapeutic one and which may have adverse
consequences for the patient may create a conflict of interest and harm the therapeutic
relationship between doctor and patient. Speaking generally, he felt that this conflict,
coupled with the large number of such assessments, meant that they were often little
more than paper exercises.
13.5 Dr Wright suggested that the ideal arrangement would be for prisoners’ general
practitioners to provide a report to an independent practitioner commissioned to
undertake their own clinical assessment. He drew a parallel with eligibility assessments
by the Department for Work and Pensions. Accepting, however, that this might not be
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