A tooth fragment was left in a prisoner's jaw which became infected and locked after he had a molar removed.

The prisoner suffered for months with bleeding and pain and was denied pain medication and given food so hard his swollen mouth couldn't eat it.

The Department of Corrections have been found in breach of regulations by failing to provide services to the prisoner with reasonable care and skill according to a report by the Health and Disability Commissioner, which investigated a complaint.

The prisoner, referred to in the report as Mr E, was in an Auckland prison.


He had his lower left molar removed under local anaesthetic on June 11, 2013 as it was badly decayed and painful.

The procedure took around 45 minutes as extraction was difficult.

The dentist gave him Pamol and gauze swabs.

After he was back in his cell, Mr E was in shock and had hot and cold flushes. His jaw was very sore and he was spitting out blood and vomiting.

A nurse visited him four hours after he asked for help.

She gave him Pamol for the pain and cotton wool balls to stop the bleeding, but neither of these were effective.

At 2am the next day Mr E woke up in severe pain. He was given Pamol by a custody officer the report stated.

"This was the only occasion that Mr E was given pain relief from a custody officer, despite multiple requests throughout June and July 2013."

Later on in the morning a nurse assessed Mr E.

"There was quite a bit of blood on his pillow case, he had blood and saliva dripping out of his mouth."

The dentist advised her to pack his mouth with gauze and give him pain relief.

"By that evening Mr E's mouth was bleeding constantly and his jaw had locked closed. The left lower part of his face and neck were swollen and he struggled to swallow."

He told a nurse that he thought his mouth had become infected, but she advised him that it was normal to have some swelling and his condition would improve the next day.

But the next day his swelling had increased to envelope his left jaw line and under his chin, he complained of constant and increased pain. The nurse consulted an on-site doctor who advised pain relief and an antibiotic were to be given three times daily for a week. But contrary to the doctor's orders these weren't regularly administered.

Mr E submitted a chit to the Health Service stating "can I please see the doctor Asap as my mouth and [throat] have swollen up and I struggle to [swallow]". Mr E would not see a doctor for another seven days. During this time he frequently requested pain medication and was refused.

The prison also failed to give Mr E a soft food diet until three days after his procedure, despite the swelling only allowing him to open his mouth 1.5cm. By June 14 he was struggling even with soft food as his jaw was swollen and locked making it hard to swallow. His diet was then changed back to regular food on June 17 without any review of his condition.

After an x-ray the radiologist noted a tooth fragment had been left in his jaw and there was a partially erupted inferior left third molar that was angled forwards on July 9.

The dentist reviewed Mr E on July 16 and advised that the tooth did not require extraction at that stage.

But almost two weeks later Mr E requested a dental appointment as he was concerned that he had an abscess in his gum.

On July 30 Mr E saw a different dentist than the one who had removed his tooth. The dentist advised that there was no inflammation or infection at the site where Mr E's tooth had been removed on June 11 and that the tooth socket was healing well.

On August 18, over two months after the tooth extraction, Mr E asked to see a doctor to get his pain medication increased as he wasn't sleeping well and his jaw still hurt.

Registered nurse Dawn Carey provided expert advice in the HDC report. She said there was an expectation that Mr E's medication would be administered as the doctors had written it based on their assessment of his pain.

"The submitted [medical administration record] demonstrated a level of incompetence to a standard that is professionally embarrassing.

"The nursing care in relation to safe medical administration was a severe departure from the expected standards."

The defendant accepts that the care provided by the Department of Corrections was below an acceptable standard, including: a failure to respond to requests for pain relief, failure to administer prescribed medication, failure to assess Mr E's condition and failure to reassess Mr E's need for a soft food diet.