Jay Harmer was a 38 year old woman who was detained at the Brisbane Women's Correctional Centre at Wacol. While in detention, Ms Harmer was found deceased on her bed by her cellmate and carer.

She had previously been admitted to the Princess Alexandra Hospital Secure Unit in relation to progressive encephalopathy. Against specialist medical advice she elected to return to the Correctional Centre in June 2016.

Background Facts

Jay Harmer was 38 year old woman who, at the time of her death, was a prisoner at the Brisbane Women's Correction Centre (BWCC). She had been imprisoned since August 2014. Although she became eligible for parole in February 2015, Ms Harmer did not progress an application at that time.

Ms Harmer had a complex medical history which included opioid dependence and liver disease due to Hepatitis C infection. Between July 2013 and early 2016, Ms Harmer's condition continued to deteriorate. In May 2016, Ms Harmer was assigned a cellmate who was also a prisoner carer to assist her with daily activities. In June 2016, Ms Harmer's health deteriorated significantly. She was transported to the Princess Alexandra Hospital Secure Unit (PAHSU) and admitted for assessment of worsening hepatic encephalopathy.

The medical assessment was that many of Ms Harmer's conditions could not be treated, and she was referred to palliative care. Ms Harmer elected to return to the BWCC while waiting for an application for exceptional circumstances parole to be considered. She died in custody sometime between the evening of 1 July 2016 and 6:45am on 2 July 2016, when she was found by her cellmate-carer.

The medical cause of death was consistent with complications of liver failure as a consequence of cirrhosis secondary to hepatitis C infection. She likely died from 'respiratory arrest due to airway compromise in the prone position, in the context of an altered level of consciousness and respiratory depression from hepatic encephalopathy and the somnolent effects of the range of medications she was taking'.

Findings

The Coroner noted that 'the standard of health care expected within corrective services facilities is required to be commensurate with that available in the general community'. He found that the health care provided by all of Ms Harmer's treating clinicians was of a high standard, despite the very challenging circumstances of her illness and imprisonment.

The Coroner concluded that Ms Harmer was unable to receive appropriate palliative care at BWCC when she returned to prison following her decision to discharge herself (against medical advice) in June 2016. The care available at BWCC was not equivalent to the care available at a hospital. However, no suitable alternatives were available. Ms Harmer did not consent to remain at hospital. She had not been granted exceptional circumstance parole. She was not directed to return to the hospital under s 21 of the Corrective Services At 2006, principally because she had capacity to make decisions about her health care.

The Coroner also considered the circumstances of Ms Harmer's application for exceptional circumstances parole. Ms Harmer's application had been delayed because the medical information submitted to the Parole Board was not the best available evidence. The application was deferred to enable a specialist opinion of her medical condition to be obtained.

The Coroner made various recommendations, including that 'the Queensland Government comprehensively review the current model for the provision of palliative care' and 'ensure that the Parole Board Queensland has access to any medical, psychiatric and psychological reports that are tendered during sentencing proceedings'. He also recommended development of formal policies for the management of prison carers, and guidelines to assist doctors preparing reports for exceptional circumstances parole applications.