The Winnunga Aboriginal health service is still absent from Canberra's jail months after an independent review found there was a need for its presence, an inquest into the death of Indigenous inmate Steven Freeman has heard.
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Mr Freeman, 25, died on May 27, 2016, two days after being admitted to the prison methadone program. The inquest is examining his admission to the program and the quality of care and supervision afforded to him in the days afterwards.
Professor Michael Levy, clinical director of justice health services, gave evidence on Thursday, and said negotiations about Winnunga's presence in the jail in fact went back six years. Mr Freeman's death had "regrettably" brought into focus again the absence of its medical services, he said.
The professor told the court Winnunga's former medical director Peter Sharp used to provide a service at the jail two hours a fortnight, but the doctor died in 2011 and the service lapsed.
He said Winnunga had rejected a government proposal to continue the service on that schedule. Professor Levy said the two hours was a starting point, and "two hours a fortnight was better than no hours a fortnight".
But barrister Bernard Collaery, who is representing Winnunga and Mr Freeman's family at the inquest, suggested the offer was rejected because two hours a fortnight was "totally insufficient" for Winnunga to adequately service the prison's Indigenous population. The professor replied he was not aware of the reason.
The professor hoped the Moss report, which recommended Winnunga be integrated into prison health care, would provide a framework for moving forward.
Mr Collaery told the court there were still negotiations to be had about the model of the health service's involvement.
Professor Levy was also questioned about the prison facilities.
As of July this year, there were 449 detainees in an expanded prison that now has "in excess" of 500 beds, the professor said.
Of the 449 detainees, 90 are indigenous, he told the court. Of the 137 people prescribed methadone, 29 were indigenous.
About four detainees were on Suboxone - a mix of the opioid buprenorphine, and naloxone, which prevents overdoses.
Professor Levy told the court the health facility had not changed since the prison opened in 2009 with an inmate capacity of 270.
The professor backed the prescribing doctor's clinical assessment of Mr Freeman when the inmate asked to be admitted to the methadone program. The doctor concluded Mr Freeman was in mild withdrawal after discussions about his drug use in prison.
But the court has heard there are doubts over Mr Freeman's account of his use of opioids and his tolerance to the drug.
Professor Levy said there had been changes made since Mr Freeman's death. For example, doctors who initiate inmates on the methadone program now had a form to complete that formalised the process of determining opioid withdrawal.
And supervision of the inmates by medical and correctional staff following admission to the program had been tightened up.
The court has heard the hours and days after a person's first doses of methadone are the most risky times for overdose.
Questions briefly turned to the inmate who died at the prison in May this year, whose death is also subject to coronial inquiry.
Professor Levy said the inmate - who has been named outside court as Mark O'Connor - was not on the methadone program.
Thursday's hearing marked the close of the inquest, and the parties will make written submissions before Coroner Robert Cook hands down his findings.
Mr Cook said he aimed to hand down his findings in December, though warned that target may not be met given the court's competing priorities towards the end of the year.
