Case one: Kamloops Regional Correctional Centre

Jeeve had multiple medical conditions due to a workplace injury and required ongoing pain management, including prescription hydromorphone. While housed at Kamloops Regional Correctional Centre, Jeeve’s medication was suddenly discontinued, causing him significant discomfort due to withdrawal and untreated pain. Jeeve complained to our office after being told by the Provincial Health Services Authority’s (PHSA) Patient Care Quality Office that the discontinuation decision was not unreasonable.

Prescribing and administering opioids is strictly regulated in correctional centres due to concerns they may be misused or shared with others in custody. The PHSA balances these risks with prescribing opioids for pain management for people in custody who need them. Following a suspected incident of misuse, a physician entered instructions on Jeeve’s medical file to discontinue the hydromorphone if caught misusing it again. When a correctional officer reported a subsequent attempt, health care staff immediately discontinued the prescription medication based on the physician’s order.

Jeeve told us that he had repeatedly raised concerns about the sudden discontinuation of his medication and its impact on his physical and mental health with both correctional and health care staff. He also said that the PHSA provided limited details about why his medication was discontinued. Jeeve’s behaviour changed in the weeks that followed and despite his significant pain and his requests for medication, the physician declined to prescribe further opioid medication. Jeeve’s secondary pain medication was then temporarily halted due to unrelated administrative errors by health care staff.

At the time of our investigation, Jeeve’s records indicated that he had continued to seek treatment for his chronic pain and had complained to the Patient Care Quality Office (PCQO). Despite his repeated requests for help, the PHSA did not reinstate his hydromorphone prescription or provide an alternative for the remainder of his time at the centre.

During our investigation, we found that the PHSA did not follow its own policy on diversion when it suspects medication misuse. We learned that the health care team had abruptly discontinued Jeeve’s medication without investigating the reported misuse, without consulting Jeeve about the alleged misuse, without tapering the medication gradually to avoid withdrawal, and without trialling an alternative method of administering the medication or providing an alternative medication. Contrary to the policy, the PHSA also discontinued Jeeve’s medication without scheduling a follow-up with the physician and it failed to complete the prescribed report documenting the reasons for the discontinuation. Jeeve’s complaints about the decision, and the significant symptoms he experienced while at the centre, did not receive an adequate response.

Despite the PHSA’s response to our investigation and its commitment to providing Jeeve with a care plan, no changes in his treatment were made before he was transferred out of BC Corrections and was no longer under the PHSA’s care. We followed up with the PHSA after Jeeve’s discharge and proposed measures to address our concerns. The PHSA agreed to:

• Audit and review all medication discontinuations and tapering related to suspected diversion for patients currently housed at the same correctional centre
• Update its diversion policy and procedures and provide in-person and virtual education programs to its staff
• Revise its complaints policy and procedure to inform complainants whether applicable policies, procedures and guidelines are followed, and to provide an explanation when not followed
• Ensure any lack of compliance with policy is flagged as an issue requiring internal review and follow-up
• Apologize to Jeeve in writing about the care he received

We received a similar complaint about the discontinuation of medication from Reggie, who was housed in a different correctional centre. These two complaints were considered together in the broader context of the PHSA’s non-adherence to its diversion policy.