COMMENTARY
Deaths in Prisons in Andhra Pradesh
Murali Karnam
A perusal of the state of prisoners incarcerated in Andhra Pradesh reveals a tragic story of denial of treatment to prisoners who are ailing and a rise in deaths of those in custody. This is indicative of the utter callousness of the prison authorities.
Murali Karnam (murali.karnam@gmail.com) is consultant, Prison Reforms Programme of the Commonwealth Human Rights Initiative.
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One hundred and twenty-nine prisoners died of ill-health in different prisons of the state in 2005-06. They included 90 pretrial detainees and 39 convicts. There were four women among them. The number of deaths recorded each year has been gradually increasing since 1991, crossing 100 in 2002-03. In the past decade and a half (Table 1), while the average prison population per day has gone up by 73%, the number of deaths in the prison has increased by 233%. This has been a serious cause of concern among human rights activists and penal reformers. The trend forecasts are also skewed disproportionately against people from economically and socially underprivileged backgrounds who are in conflict with the law. The socio-economic data of the prisoners shows that the penal system is executing them silently without being ever made accountable.
Records relating to deaths of prisoners inform the nature of healthcare provided to prisoners and reasons for their death. The law mandates that health screening of prisoners should be done at the time of their admission into prison.1 The law can be complied with, at least in large central prisons where a rudimentary medical staff is available, but this is completely dishonoured. The medical records routinely claim that the health of the prisoners at the time of their admission is satisfactory. As a result, serious injuries sustained d uring police custody – which is not
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u n common in case of those accused of theft and dacoity – are not detected before the prisoner succumbs. Only four out of 120 prisons in the state have pathologists and that too without full-fledged laboratory facilities. Inmates are provided just symptomatic treatment for all diseases without any proper diagnosis. This is evident from the variances between the treatment provided to the diseased on the basis of the diagnosis and the final causes of deaths diagnosed by the For ensic Laboratory, Hyderabad.
The attitude of prison medical officers who suspect that prisoners’ complaints are part of malingering (such suspicion is shared by security officers) compounds the problem. The lack of psychologists and psychiatrists further exacerbates the situation. All these factors contribute to undue delay in detecting serious health problems. The delay in the medical treatment provided can be observed merely from the fact that in most of the cases either prisoners are brought dead to hospitals, or admitted in the hospitals just few hours or one or two days before they succumb to death.
The very structural nature of prison life is conducive to such deaths which are otherwise preventable. Prisoners are routinely locked away in their barracks at night. There is a prisoner in charge of night duty, a warder who comes by to check the locked barrack once each half hour or so, and a night paramedic. When an inmate is suddenly taken ill or in acute pain he can at best inform his neighbours. They will inform the prisoner on night
Table 1: Deaths in Prisons in Andhra Pradesh
(As on 31 March of respective years)
| Year | Convicts | Undertrials | Total | Deaths |
|---|---|---|---|---|
| 1991-92 | 3,252 | 5,441 | 8,693 | 39 |
| 1992-93 | 3,876 | 7,304 | 1,180 | 44 |
| 1993-94 | 3,968 | 8,499 | 12,467 | 58 |
| 1994-95 | 3,671 | 8,066 | 11,737 | 56 |
| 1995-96 | 3,475 | 9,924 | 13,399 | 56 |
| 1996-97 | 3,395 | 10,292 | 13,687 | 63 |
| 1997-98 | 3,076 | 8,705 | 11,781 | 58 |
| 1998-99 | 4,076 | 10,534 | 14,610 | 91 |
| 1999-2000 | 3,935 | 9,357 | 13,292 | 72 |
| 2000-01 | 4,202 | 8,193 | 12,395 | 84 |
| 2001-02 | 4,434 | 8,140 | 12,574 | 80 |
| 2002-03 | 5,123 | 7,834 | 12,957 | 112 |
| 2003-04 | 5,290 | 9,102 | 14,392 | 110 |
| 2004-05 | 4,908 | 9,054 | 13,962 | 111 |
| 2005-06 | 5,099 | 9,802 | 14,901 | 130 |
| Table 2: Social Background of the Dead in | ||
|---|---|---|
| COMMENTARY | No | % |
| 1 Scheduled castes Prison Custody in Andhra Pradesh | 34 | 26.3 |
| 2 Scheduled tribes | 21 | 16.2 |
| 3 Backward classes/ | ||
| castes 50+ Muslims 8 | 58 | 45.0 |
| 4 Other castes | 08 | 06.2 |
| 5 Caste unidentified | 08 | 06.2 |
| Total | 129 | 100 |
Table 3: Educational Background of Dead Prison Inmates
No %
| 1 Illiterates | 78 | 60 |
|---|---|---|
| 2 Primary education | 31 | 24 |
| 3 Up to matriculation | 11 | 08.5 |
| 4 Above matriculation and | ||
| below graduation | 7 | 05.5 |
| 5 Graduates | 0 | 00 |
| 6 Postgraduates | 2 | 01.5 |
| Total | 129 | 100 |
duty. He, in turn, will inform the warder when he comes by on his rounds. The warder will inform the paramedic who will convey the message to a deputy jailor and together they will open the barrack to investigate. But, to safeguard against untoward incidents, the barracks will only be opened if there are sufficient back-up guards. Only then will the resident medical officer be called to attend on the patient if such a doctor is available. If the doctor recommends emergency treatment outside the prison, all security measures will be strictly followed while unlocking and locking the barracks and the inner and outer prison gates. At the very minimum the process from complaint to release takes anywhere between one and two hours. Relief may still be some miles and more hours away. Violent protests by prisoners at the delay inherent in these procedures when a fellow inmate is taken ill are not uncommon and senior officers agree in private that deaths, especially from cardiac incidents, could be avoided if dealt with speedily.
Violation of Procedures
A lot more procedures are violated by the authorities at different stages even after the death of the prisoners to cover up their negligence and escape from accountability. Prison rules2 mandate that the prison chief must intimate the serious illness of prisoners to their families. But they are informed only after their death. The law expressly prohibits3 the presence of police and prison personnel at the time of inquest and inquiry but the records show their presence and manipulation of the facts. The inquest and inquiry reports carry prison officers’ versions of the causes of deaths, which most of the time are completely diffe rent from the facts gleaned from postmortem examination reports. Magisterial enquiries of the deaths are routinely conducted after two to three years. As an illustration, in Hyderabad, Guntur and Chittoor districts, the government took until 2007 to announce magisterial enquiries on the deaths that occurred in 2003. These enquiries do not care to record the opinions of prisoners who actually saw the suffering of their inmates. The state does not consider the opinion of the prisoners worth recording. In a nutshell the entire procedure appears to i gnore facts of the case and not fully i nterested in identifying the personnel responsible for the death of the convict or making them accountable for the lives lost. The governments do not consider these lives of such inmates worthy of a ttention because they are from the economically and socially disadvantaged sections of society.
Social Background
Of the 129 prisoners who died in custody in 2005-06, 34 were from scheduled castes, 21 from scheduled tribes, 58 from backward castes/classes and eight from well-off classes. Most of the prisoners belonging to scheduled tribes are indigenous communities such as Bagatha, Koya, N ayakapodu, Jathapu, Gond, Kollam, Y anadhi and Yerukula who survive on food gathering from forests. While scheduled castes and tribes together constitute only 22.5% of the total free population of the state, they constituted 38% of the prison population4 and 42.5% of those who died in prison (Table 2). Sixty per cent of the dead were illiterates and the rest had only primary schooling (Table 3). These facts unambiguously show the v ulnerability of these sections of society in prisons in the state.
Professional Background
The official records of these deaths had not recorded the details of the professional backgrounds of the prisoners in any systematic manner. Those records are available only in the cases of a few prisoners: agriculture labourers, hotel workers, b eggars, social workers, lorry drivers, a griculturists, stone cutters or rickshaw pullers. One can safely assume that this is indicative of most of the prisoner population. Nearly 89.5% of the dead are from able bodied-age groups. This is indicative of the sub-human living conditions that render life in incarceration vulnerable.
Post-mortem reports and the reports of the Forensic Laboratory indicate the c auses of death (Table 4, p 21).
Andhra Pradesh Prison Rules5 provide for the consideration of release of prisoners suffering from incurable and terminal diseases. It identifies 15 such types of diseases, which include tuberculosis, heart diseases, hypertension and serious neurological problems. Needless to say, AIDS is also to be included among this list. It is clear from the types of ailments listed
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COMMENTARY
above that some prisoners ailing from the diseases listed could be freed to spend their last days with close kith and kin. But the lethargy and indifference of p ersonnel at different levels who are required to process such releases – considered unreasonably time-consuming – results in unnecessary deaths in custody. If the same medical grounds were considered by judiciary, a number of detainees in trial could have escaped death. But that requires a culture of accountability among those who are supposed to process the release owing to ailing from such diseases.
Healthcare in the Prisons
The Supreme Court of India has emphasised the society’s obligation towards prisoners’ health for two reasons.
First, the prisoners do not enjoy the access to medical expertise that free citizens have. Their incarceration places limitations on such access; no physician of choice, no second opinions, and few if any specialists. Second, because of the conditions of their incarceration, inmates are exposed to more health hazards than free citizens. Prisoners, therefore, suffer from a double handicap.
This understanding hardly informs the prison healthcare policy of the government.6 The prison medical service is under dual control of the prisons department as well as Directorate of Medical and Health Services (DMHS). The government budget for healthcare in prisons is inadequate. Generally one deputy civil surgeon, an assistant civil surgeon and one pathologist are appointed to each central prison and one assistant civil surgeon for each district jail is appointed on deputation from the DMHS. This policy more than satisfies the prison rules, but is still grossly inadequate to address the primary medical needs of the prisoners. The prison department does not have the power to recruit medical
o fficers based on its own assessment of needs and health conditions. Neither has DMHS instituted a specialist branch to suit the particular health requirements of prisoners. There are no specific policy guidelines on the appointments of m edical personnel, tailored to address the needs of the prison population. The director of medical and health services, who decides
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h ealthcare policy in prisons rarely visits prisons.7
While hiring doctors, the prison department is not involved in any need-assessment of the special circumstances pertaining to the prison environment. The reason for taking doctors on deputation instead of direct recruitment, the prison authorities say, is that these are not considered as prospective avenues for a career in the department. When career options take primacy over the health needs of prisoners as the criteria for the manning of essential services such as healthcare, the increase in death toll is hardly surprising.
Prison regulations state that in all prisons where there are more than one medical officer, one officer is required to be present on the premises and available for e mer gencies. In jails where there is only one a ssistant surgeon, he is required to r emain inside the jail throughout the day and visit the jail hospital occasionally at nights. This is an unreasonable and impossible expectation, and made even more unreasonable by the lack of accommodation close to the prison or provided to medical staff. But even where medical officers are provided residential quarters, they do not actually stay in them. Without insistence on this, the purpose of having a “resident” medical officer is substan tially defeated.
The state of healthcare in district jails is even more precarious. Even where sanctioned posts exist, willing doctors are hard to come by. Prison medical services are not the preferred career option for most well-qualified doctors, let alone specialists. Prison medical services have not been addressed in medical college curricula as a dedicated branch of study. For the past five years, five out of nine district jails – at Nizamabad, Vijayawada, Guntur, Karimnagar and Sangareddy – have been forced to hire the services of assistant civil surgeons on an annual contract basis. Some of these medical officers travel from adjacent big cities to the prisons. Prisoners complain their services are not available even in daytime during holiday periods.
Healthcare in Sub-Jails
Sub-jails are located in small towns far away from the vigilant eyes of the media and policymakers in government. They house only the pre-trial detainees.
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Healthcare in these jails is practically non-existent and has been a matter of grave concern since 1999, when a writ petition was filed in the high court.8 At the end of 2001, the government promised in the legislative assembly to appoint medical officers to open-air prisons and subjails on a contract basis. However, the government, after considering the promise for two years, decided in 2004 to entrust the work of providing medical facilities to the inmates of all the sub-jails to the medical officers of the concerned Primary Health Centres (PHC) on the payment of a honorarium of Rs 350 per month, prescribing one visit in 15 days to any given subjail.9 During the visits they are expected to undertake health check-ups of inmates and refer suspected cases of tuberculosis, cancer, diabetes and eye problems to
Table 4: Diseases Responsible for Prisoners’ Death
Number of Prisoners
TB (Bilateral Pulmonary Tuberculosis,
Chronic Anaemia resulting TB, Pulmonary Oedema) 26 Heart Diseases (acute Myocardial infarction-18, Ischemic heart disease-5, heart-related-20) 43
AIDS 13
Hypertension and Haemorrhage
Liver related (cirrhosis-3, hepatitis-2, jaundice-1)
Multiple organ failure
Neurological
Fever (malaria-2, typhoid-2)
Acute gastritis
Hernia 01
Chronic infection
Septicemia
Paralysis 01
Suicide by hanging
Hyporolaemia
Multiple injuries
Pending with forensic laboratory
No information available
Total 129
nearby hospitals. The public healthcare system which itself is in crisis is expected to come to the rescue of prisoners in 106 sub-jails and three district jails. Neither these PHCs nor sub-jails have ambulance facilities to transport ailing prisoners. The response of the state to the order of high court is just an eyewash considering the fact that over 500 doctors’ posts have been vacant for years.10 The right to p roper healthcare of prisoners was s acrificed for the lack of resources and b ecause of the non-functioning public healthcare system.
COMMENTARY
A look into the history of prison healthcare policy reveals the commitment of the state to the rights of prisoners. In 1966, the govern ment delegated powers to the director general of prisons to incur an amount of Rs 2,500 per annum towards hospital charges.11 The request to change this order and delegate more powers to the director general was pending for more than two years since 2002. Finally, the government accorded permission to the director general of prisons for the sanction of amounts worth Rs 75,000 for all diseases and Rs 1,00,000 for kidney transplantation, bypass surgery, cancer and neuro surgery towards hospital c harges for the treatment of prisoners.12 Whenever a concern is expressed about the state of healthcare system in prisons, the above government order is often c ited as indicative of the best policy a vailable to prisoners. This benevolent a pproach of the government has not arrested increasing prisoner deaths as primary healthcare is simply not available from the day of their admission and is not part of institutional culture.
Since the prison medical system can at best only treat common ailments, ailing prisoners must be sent to local government hospitals for diagnosis and treatment, and in emergencies. All central and district prisons have only multi-purpose vehicles, which are also used as ambulances, but they are more like goods carriages. There are no special drivers particularly meant for driving ambulances; generally warders are trained to provide that service in emergencies.
The shortage of security staff to escort sick inmates for outside treatment or admission into hospital is universal and exacerbates the risk to prisoners. The prison administration is unable to meet the demand for transport to court for production; the majority of medical escorts are provided on Saturdays when there is less pressure for judicial escort duties.
What Is Happening?
A lack of quick medical attention is one of the most important reasons for prison deaths. In almost all cases, prisoners were admitted to specialist referral hospitals
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l ocated far from the prison just one to three days before their death. In more than half a dozen cases, they were brought dead to the hospital. Escorts are not made available to the prisons by the police department until the prisoner is too critical to survive. The whole process takes far too much time and can prove costly in terms of human life. In 2003, the government was aware of the fact that prison deaths due to a lack of timely police escort was increasing.13 The government then sought from the prisons department detailed data for 10 years on the number of deaths due to the absence of police escorts. The result of this focus by the government is not known but the number of deaths has still been going up.
Mentally Ill Prisoners
It is clear that prisoners are more vulnerable to mental illness under the regime of control, overcrowding, enforced solitude, lack of privacy, lack of meaningful activity, insecurity about future prospects and inadequate health services. Research on prisoners uniformly indicates that the
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COMMENTARY
stress of incarceration increases the incidence of mental illness.14 The Andhra Pradesh government does not at present collect systematic data on the incidence and treatment of mental illness amongst prisoners, but there is little reason to believe that these trends are not replicated. In the absence of special training of regular staff, with marginal medical systems, and no visiting specialists, it is only the violent, noisy or acutely ill mental patient who can hope for attention. Others with no less distressing but less obvious or visible conditions must live through incarceration without hope of any medical care.15
To sum up, the treatment of accused prisoners and convicts having died in custody tells a tragic story. They are disproportionately punished with death and most of them even before trial. Yet ironically, the refrain about civilised treatment of offenders and reformation of the criminal resounds in the corridors of power.
Notes
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2 Rule 51 of Andhra Pradesh Prison Rules 1979.
3 Rule 576(2) of Prison Rules.
4 National Crime Records Bureau, Ministry of Home Affairs, Government of India, 2005. 5 Rule 320(f) Chapter 21. 6 The Supreme Court of India: in Rama Murthy vs
State of Karnataka (1997), 2 SCC 642. 7 Prison rules mandates visits to prisons by the director of medical and health services once in three months. He did not visit a single prison during 2004 and 2005: Andhra Pradesh Prisons: Behind Closed Doors, published by Commonwealth Human Rights Initiative, New Delhi, 2006.
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8 Writ Petition No 1061/1999 filed by P R Subas Chandran and subsequent order by high court dated 10 August 2001.
9 GOMs No 261, Home (Prisons-B) Department, dated 23 November 2004. 10 The Hindu, dated 13 November 2006. 11 Government Order No 970 Home (Prisons) Department dated 7 May 1966. 12 Government Order No 77 Home (Prisons B1) Department dated 12 March 2004.
13 Memo No 46659/Pri B2/98-14 dated 16 October 2003, Home (Pri B2) Department, Government of Andhra Pradesh.
14 A study in UK found that 1% of men and 0% of women among the free population suffer from some form of mental illness, whereas in prisons 44% of men and 62% of women suffer from mental illness, Reducing Re-offending by Ex-prisoners, The Social Exclusion Unit, Office of the Deputy Prime Minister, London, 2002, pp 23-23.
15 In India there are an estimated four million people with schizophrenia alone, with different degrees of impact on 25 million family members. However, there is only one psychiatric bed for every 40,000 people and 0.4 psychiatrists for 1,00,000 people. The primary reason for this pathetic state is spending of just 0.83% of the total health budget on mental health. World Health Organisation (2001): Atlas – Country Profiles on Mental Health Resources, WHO, Geneva.
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