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Healthcare behind Bars

26.09.2017

 
Natia Gogolashvili 

“Each time I was taken from the penitentiary facility for medical examination, each tablet of the prescribed medicine affected my nerves. The medical department was violator,” former convicted M.D is speaking about the violations which she encountered during the medical treatment in the penitentiary establishment. During the imprisonment term, the former prisoner was operated four times. Because of weak bones her limbs were broken several times.

“During the imprisonment term, the rights of the convicted M.D were breached almost every day. She was not provided with the adequate medical treatment. Moreover, there were several facts when she was taken from the facility but was not brought to the hospital, though the medical form # 100 was issued,” the lawyer of Human Rights Center Nestan Londaridze said.

The former convict continues medical treatment now already outside the prison. The pardon commission took her health conditions into account but many other inmates still continue medical treatment inside the facilities. 

Humanrights.ge inquired about the present problems and challenges of the penitentiary medical system and what positive reforms were carried out in the field.

Head of the National Preventive and Monitoring Department of the Public Defender’s Office Nika Kvaratskhelia said recently several significant steps were taken in the field of penitentiary healthcare, services were improved but the problems still remain.

“Before 2012, in fact, it was mostly impossible to get adequate medical treatment. Nowadays, this problem is more or less resolved but we cannot say that the system has already achieved the level, when the penitentiary medical department provides all patients with adequate service,” Nika Kvaratskhelia said.

Advisor to the Minister of Corrections Sofo Morgoshia told humanrights.ge that since 2013, the Ministry commenced in-depth reforms in the field of medical treatment. 

“We have center for the treatment of tuberculosis and hospital for the accused and convicted patients. Both facilities were renovated, rehabilitated and equipped with the modern medical apparatus. Within framework of the projects of the Council of Europe and EU, the Ministry signed grant agreement based on which the Ministry received new medical apparatus. In accordance to the recommendations of the Red Cross and the World Health Organization, first medical aid units were arranged in all penitentiary facilities, which were staffed with medical personnel,” Sofo Morgoshia said.

Human rights defenders said, regardless positive changes in the system, there are problems in the penitentiary healthcare system. 

Access to doctors and medical personnel/competence of the medical personnel

In accordance to the 2016 Report of the National Preventive Mechanism of the Public Defender’s Office, as of 31 December 2016, there were 9,334 prisoners (remand/ convicted persons) in the penitentiary system; there were 190 doctors and 265 nurses employed in penitentiary establishments.

The Ministry of Corrections state the number of the medical personnel is enough. Public Defender does not agree with the position of the Ministry and believes that sufficient number of doctors and nurses shall be available in every facility so that the accused and/or convicted persons could receive the medical assistance timely. HRDs also indicate those facilities, which do not have doctors of concrete categories. At the same time, the competence of the medical personnel is also the issue. 

“They do not have doctors of specific categories in the prison # 3 or if they have, but the needs of the prisoners are very rarely met; the doctors with relevant profiles hardly assist the inmates. At the same time, inmates of the prison # often complain about the doctors. We often receive complaints from the prisoners about one and the same doctors. It is necessary that the prison administration paid attention to those complaints,” HRC lawyer Eka Lomidze said.

“In penitentiary establishments nos. 2, 14, 15 and 17, the correlation of the number of prisoners with the number of doctors and nurses is high. It should be mentioned that when calculating the correlation, the schedule of shifts of doctors and nurses is not taken into account. According to the European Committee for the Prevention of Torture, staffing levels should ideally be equivalent to roughly one medical doctor for 300 prisoners and one qualified nurse for 50 prisoners. In 2014 and 2015, the Public Defender of Georgia recommended to the Minister of Corrections to ensure sufficient number qualified doctors and nurses in all penitentiary establishments for timely and adequate provision of medical services. According to the response received from the Medical Department of the Ministry of Corrections based on the recommendation of the International Committee of the Red Cross, the correlation of doctors and prisoners in small establishments is from 50 to 150; and from 300 to 500 in large establishments,” the 2016 Report of the NPM reads. 

“Mostly the doctors and nurses of general profile work in the first aid medical units. They provide the inmates with timely assistance. As for the doctors of concrete profiles, we have contracts with about 60 doctors and in case of necessity, they enter the penitentiary establishments,” Sofo Morgoshia said. 

HRC lawyer Eka Lomidze said the competence of the medical personnel in the penitentiary establishments is serious issue. As human rights defender, she said in some cases the doctors provide the patients with superficial medical assistance. 

Nika Kvaratkhelia of the PDO National Preventive and Monitoring Department said the doctors and nurses working in the penitentiary system shall improve their professional qualifications because the competence of the medical personnel is still significant problem.

Sofo Morgoshia, advisor to the Minister of Corrections in the affairs of healthcare, said the medical personnel take some trainings and workshops. “Suicide prevention program was innovation for our system. We trained all doctors, nurses, psychologists, social workers and personnel of regime and security services in this direction. With the assistance of the CoE and EU, we trained 15 psychiatric nurses as trainers.”

Medical referral/electronic line

The first link, which is in charge of the primary health-care, is at a penitentiary establishment determines on its own the need for specialised medical service for prisoners and requests referral of a patient by registering the request in a software. The convicted patient is registered by the program; only planned patients enjoy the service by electronic system. Emergency cases go beyond the line. The electronic database for Eastern and Western Georgia is separated and are regulated separately. Both civic hospitals, center for the treatment and rehabilitation of tuberculosis and the jail hospital # 18 provide the prisoners with medical assistance. 

“Based on the Minister’s order, a commission was set up, which reviews the needs of patients, coherence of the documents with his/her needs and makes decision when the patient will be sent to hospital (immediately or according to the queue), the Ministry notified.

According to the NPM’s report, the Medical Department of the Ministry of Corrections processes the requests on first-come, first-served basis, taking into account the seriousness of the incident and the time needed for dealing with it in a qualified manner. Therefore, the Department does not take into account such cases where the health condition of a patient on the wait list is gradually deteriorating but not to such a degree as to qualify for emergency medical treatment.

Accessibility to medicines 

The basic drugs list of the penitentiary health-care system determines the list of those medicines, which the Ministry of Corrections took commitment to provide at its own expense. In the Parliamentary Report of 2015, the Public Defender pointed out the problem of replacing prescribed medicines as well as the deficit of medicines in penitentiary establishments, including the medicines for cold. The Ombudsman continued speaking about this problem in 2016 too. 

“As the monitoring of penitentiary establishments showed, medical personnel mostly prescribes to prisoners those generic medicines that are already available in the given penitentiary establishment, at the state’s expense. It is imperative that prisoners are allowed to purchase, with a doctor’s consent, a particular brand of medicine that corresponds to the initially prescribed medicine, in the given penitentiary establishment’s drug store or, if there is none, to get it through family members,” the 2016 Report of the NPM reads. 

“There are cases when the prisoner asks for the concrete medicines because it is the most effective for him. He is denied to get the requested medicine claiming that they need doctor’s conclusion. To get the doctor’s prescription, the doctor shall enter the facility, examine the patient and prescribe the concrete medicines. Often, the problems are created about the purchase of the medicines because they are not prescribed by the doctor. Consequently, the patients mostly get incorrect medicines but the medical personnel does not think it is violation,” HRC lawyer Eka Lomidze said. 

The lawyer added that the process of prescribing the medicine is a lengthy process that is problematic for the patient and delays the medical treatment process. Sofo Morgoshia said it does not take long for the doctor to enter the facility, issue consultation to the patient and prescribe the doctor – it lasts 7-10 days. However, Eka Lomidze said meanwhile the patient may endure unbearable pains only because that he needs concrete medicine instead the one the facility offers him.

Control of the Medical Service

Advisor to the Minister of Corrections Sofo Morgoshia said the Ministry fulfilled the recommendation of the Public Defender and created a service to control the quality of the medical service within the General Inspection of the Ministry. The new service was established in December of 2016. Sofo Morgoshia said the respective department ensures the control of the medical service quality, carry out infrastructural evaluations and react to the complaints of the concrete convicts and accused persons.

Nika Kvaratskhelia, head of the NPM Department at PDO, said the main recommendation of the Public Defender was to establish the system to control the quality of healthcare. “Penitentiary healthcare shall be unified with the national healthcare and the control system shall also be unified. Today, there is the institution which controls the quality of medical service but it requires significant improvement,” Nika Kvaratskhelia said. 

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