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Reform strategy of medical care for prisoners (updated)

18.01.2022
Mykhailo Romanov, Yevgeniy Zakharov

We have already published the views of human rights activists on the further development of penitentiary medicine in Ukraine. Today we bring to your attention an updated and supplemented vision of how this sector could be reformed.


Introduction

The state of medical care for convicts (especially those serving sentences of physical isolation from society) is extremely poor today. The incidence of dangerous diseases among convicts, including infectious ones, can pose a danger not only to other convicts, but also to free people, because convicts communicate with staff, visitors, and they are released and through them the diseases can spread among the free population. An example is the evidence of studies showing that the incidence of tuberculosis among detainees/convicts is 22 times higher than among the general population.

All this indicates that medicine in the State Penitentiary Service needs systemic and comprehensive changes, the ultimate goal of which should be to create an appropriate and functional system of medical care for convicts sentenced to physical isolation from society, and detained persons. This system should be focused on providing medical care and support to sick people.

Today, the reform of penitentiary medicine is one of the “trends” of the industry. This problem is in the field of view of both national authorities and international institutions. The Penitentiary Reform Passport, which appeared on the side-lines of the Ministry of Justice in 2017, provided for active changes in this area of activity. Its existence was mentioned by the Kharkiv Human Rights Protection Group in a report by Iryna Skachko. In addition, in 2017 the Concept of reforming (development) of the penitentiary system of Ukraine (hereinafter - the Concept) was adopted. The Concept identified the situation with the provision of medical care to convicts and prisoners as one of the systemic problems.

From that moment on, both the Ministry of Justice returned to the issue of reform from time to time (speeches of the heads of the Ministry of Justice on social networks and mass media (interviews, comments, etc.), and the Human Rights Commissioner of Verkhovna Rada of Ukraine (monitoring visits, appeals and submissions, etc.). Human rights organizations also paid considerable attention to the problem of medical care for convicts. In particular, the Kharkiv Human Rights Protection Group pays attention to the medical care of convicts and detainees in almost every report on the results of monitoring visits to penitentiary institutions. But unfortunately, no significant changes in the direction of the declared transformations during these four years have taken place.

In our opinion, the main reason that the reform did not actually take place is, firstly, the lack of understanding of the ultimate goal of medical reform. The formulation of the goal with the help of the thesis “to make it good” indicates its uncertainty. The lack of the ultimate goal of the reform will not allow to choose the methods, means and mechanisms of the reform. And the second reason is the lack of political will to implement real transformations.

And while the issue with the second reason remains open, the first can be completely solved by formulating such a goal.

Of course, in order to successfully implement the reform of penitentiary medicine, it is necessary to take into account that the medical sector itself is in a state of reform. Therefore, there is a need to integrate one reform into another. In this process, it is important to be aware of the peculiarities that exist in the field of execution of sentences and which are associated with the existence of significant restrictions imposed on convicts and prisoners. 

The main problems of penitentiary medicine

 Let’s identify the main problems to determine the range of issues that need to be addressed:

1.    Subordination of medical staff to the administrations of penitentiary institutions, and penitentiary medicine – to the purpose of punishment. The problem is that today there is a deep tradition, the content of which is the provision that a convict is, first of all, a punished person who does not “deserve” a normal human attitude. Accordingly, if the convict is ill, this circumstance is perceived as part of the punishment, i.e. part of the suffering that the convict must experience. Thus, the medical staff is in no hurry to provide medical care, given that the convict must be punished, and care for his physical condition is an optional element of the process of serving the sentence. 

2.    Inadequacy of the infrastructure of penitentiary institutions and pre-trial detention centres for the provision of medical care and treatment. The problem follows from the previous one: by not perceiving the convict as a person, the state does not take care to create humane conditions for the detention and provision of convicts. That is why penitentiaries are adapted to provide suffering, but do not have the appropriate infrastructure to care for a person. Especially one that needs medical attention. There are no proper premises, equipment or conditions for medical care. 

3.    Insufficient number and even lack of medical staff. Nowadays, the State Criminal Executive Service is experiencing a significant shortage of officers to enforce criminal penalties, including the need for medical personnel. Especially for qualified medical workers who are able to diagnose the patients, prescribe and monitor the treatment of patients, as well as make operational competent decisions during the course of the disease. The staffing of penitentiary institutions with such employees is a significant problem. 

4.    Insufficient provision of medical units with medicines and equipment for diagnosis and treatment of convicts and prisoners. Underfunding of SCES in general and HC of SCES and medical units of institutions in particular creates a state of chronic inability to provide medical services within the system. Lack of medication, lack of necessary equipment, inability to provide timely and complete medical care lead to the fact that even the efforts of medical staff become illusory due to their ineffectiveness. 

5.    Inconsistency of actions between the structural subdivisions of the SCES and between the HC of SCES and the Ministry of Health of Ukraine in providing medical care and treatment of convicts. The lack of clearly defined functional priorities in the implementation of criminal penalties (for example, the lack of a clear indication that human safety, life and health are the main criteria for the effectiveness of SCES) leads to the fact that even within SCES there are no consistent and clear algorithms of interaction, especially in the field of medical care. Numerous decisions of the European Court of Human Rights indicate that very often medical care is provided too late, not in full, with long breaks, and so on. All this indicates that the structural units of SCES are not able to make operational managerial and executive decisions and interact with each other. 

6.    Failure to comply with medical treatment protocols during the provision of medical care to convicts, failure to provide continuous and uninterrupted treatment of convicts, lack of efficiency and timeliness of medical care. This problem is cumulative, as it is related to all the previous ones, which together lead to the negative consequences that develop in practice in the provision of medical care: lack of interaction between medical staff of SCES and MoH specialists, understaffing and lack of necessary equipment, priority of implementation of punitive (executive) function ultimately lead to non-compliance with medical protocols for treatment of convicts and detainees, incompleteness, interruption and untimely assistance. This circumstance is not only a violation of medical regulations, but also an ethical and legal problem, as it is related to the state's failure to protect human rights, failure to ensure the security of society. This situation makes it normal to leave a person in danger and endanger the health of both the convict or detainee and the people around him. 

7.    Mutual mistrust between the convicts/detainees and the staff of SCES. In the context of medical care for convicts and detainees, the problem is that the administration of the institutions has a negative attitude towards those convicts who complain about their health, perceiving them as simulants.: those who evade the regime, those who want to be released early, or to receive some mitigation in detention or to go to hospitals. For their part, convicts distrust staff and doctors, trying to maintain a balance between maintaining health and reducing their own vulnerability as a patient and one in need of additional care. 

8.    Lack of special regulations and understanding of the need for individual approaches to convicts with special needs, in particular to those who need constant medical care, treatment, special therapeutic measures (patients with diabetes and other chronic diseases that require constant medical care or treatment, HIV-infected, drug and alcohol addicts, people with disabilities, etc.), as well as the elderly persons in need of care.

In summary, the problems identified are due to several factors:

1. General lack of humanism in the penitentiary system (ability to treat a convict as a person).

2. Inability to distinguish between execution of punishments and health activities. We mean that in penitentiary institutions all measures (including treatment) are subordinated to the purpose of punishment (a convict is the one who has to suffer).

3. Lack of traditions of penitentiary medicine. This means that prison medicine did not exist as a field of activity and, accordingly, there is no awareness of its necessity, no understanding of the specifics of medicine for people in physical isolation and which are supposed to be resocialized through such isolation, nor an understanding of causal links between individual social phenomena and, as a consequence, the inability to understand the problems arising from existing problems within the penitentiary system (the state of health care in places of detention and the state of public health).

4.  Lack of adequate funding and provision of penitentiary medicine. Reform of the penitentiary system has been ongoing since 1998. Given this period, today referring to the “for lack of funds” is in the nature of improper performance of the duties of the relevant officials (not only and not so much of the State Criminal Executive Service), rather than the actual shortage of funds. This is particularly relevant given the amount of compensation that Ukraine pays under ECtHR decisions in the “medical” cases of prisoners each year.

We would like to note that penitentiary medicine must address these issues. To do this, it must be independent, accessible, prompt, effective and mobile. 

Measures to improve the situation

Measures that, in our opinion, should be implemented in the penitentiary sphere:

1.    To solve the problem of subordination of medical personnel to the administrations of penitentiary institutions, and penitentiary medicine – to the purpose of punishment, it is necessary to put an end to the issue of transferring the entire medical service of the SCES to the Ministry of Health of Ukraine. We believe that in this process it is necessary to realize that the issues of administration should not be replaced by issues of managing the property of medical institutions of SCES. First of all, the process of transferring all medical staff of the SCES to the Ministry of Health of Ukraine should take place. This applies to the registration of labour relations of medical staff, as well as its provision, financing, social security, certification, etc. As for the property now owned by the HS of SCES, its fate should be decided by the SCS, but with due regard to the fact that medical staff, in addition to financial and social security, must have the material and technical base necessary to provide medical services. Therefore, it is expedient to transfer the relevant property (or part of it), which will provide a real opportunity to provide medical services to convicts, to the MoH of Ukraine.

We believe that the employees of the State Institution “HC of SCES” should be dismissed and employed in medical institutions of the MoH or (if desired) to practice medicine as  individual entrepreneurs. Such persons need to set appropriate surcharges and allowances for their work. As for the property now owned by the HC of SCES, we consider it expedient to transfer the entire medical infrastructure to the MoH, re-equip it and prepare it for the treatment of convicts and prisoners.

The second important point is that the perception of the convict as a stigmatized punished person actually leads to the perception of the convict's illness as part of the suffering, which, in turn, is the norm for the convict. Therefore, such treatment of the convict must be eradicated. And it is cooperation with civilian doctors that increases the chances of overcoming such a stereotype about convicts. We believe that cooperation with civilian doctors increases the chances of overcoming such a stereotype about convicts.

2.    Inadequacy of the infrastructure of penitentiary institutions and pre-trial detention centres for the provision of medical care and treatment. The problem is solved by updating the material and technical base of places where convicts and detainees receive medical care. In addition, it is necessary to re-equip penitentiary institutions and their individual premises and the medical units themselves in order to create the necessary conditions for the provision of medical care. We are talking about the allocation of premises for the isolation of patients with infectious diseases, the proper arrangement of the premises of medical units, diagnostic rooms, wards for temporary or permanent accommodation of patients in need of inpatient care. Solving this problem requires adequate funding and changes to the architecture and formation of the internal space of penitentiary institutions. We believe that postponing the resolution of this issue to “better times” is unacceptable. If the state finds funds for compensation payments according to the decisions of the ECtHR, it is able to find funds for the reform of penitentiary medicine.

3.    Insufficiency and even lack of medical staff. Problems need to be solved comprehensively in cooperation with the MoH of Ukraine. Of course, working with convicts and detainees is intense and has increased levels of stress and danger. Therefore, health care workers who work in such conditions should receive appropriate compensation and benefits that are associated with overload. It is necessary to introduce a system of allowances and surcharges for work in penitentiary institutions, as well as to provide for mandatory rotation of medical workers and opportunities for their rehabilitation. Such working conditions will make it possible to attract more qualified medical workers to penitentiary institutions and replenish their staff. Additional financial support for medical employees working in penitentiary institutions solves an additional task – prevention of corruption and reduction of corruption risks in working with convicts.

4.    Insufficient provision of medical units with medicines and equipment for diagnosis and treatment of convicts and detainees. This problem is solved by comprehensive long-term planning and forecasting of activity of medical institutions, as well as by providing them with the necessary minimum of medicines and equipment that will allow at least the initial examination and diagnosis of most diseases, as well as to perform basic, including urgent, manipulations and research. The solution to this problem can be achieved through constant adequate funding of penitentiary institutions and, in particular, their medical units and institutions.

5.    Inconsistency of actions between the structural subdivisions of the SCES and between the HC of SCES and the MoH of Ukraine in providing medical care and treatment of convicts. Due to the desired liquidation of the State Institution “HC of SCES” there will be a need for regulation and joint development of the SCES and the Ministry of Health, the order and algorithms of interaction in certain circumstances and in connection with the diagnosis of relevant diseases. Settlement and elimination of such condition is possible by means of normative regulation and joint work by the specified structures, in developing the order and algorithms of interaction in certain circumstances and in connection with diagnosis of the corresponding diseases. It is necessary to determine the main course of action in certain situations, which would allow to promptly and quickly respond to the painful conditions of convicts and detainees in order to prevent untimely and incomplete medical care, as well as to effectively interact with other medical professionals.

6.    Failure to comply with medical treatment protocols during the provision of medical care and treatment of convicts, failure to provide continuous and uninterrupted treatment of convicts, efficiency and timeliness of medical care. It is planned to solve this problem through general rules and requirements for the provision of medical care and the introduction of insurance against poor quality medical services, which is currently being discussed at the national level. This should be supplemented by the formulation of a doctrinal provision in the criminal-executive legislation on the priority of protection of life and health of the convicts in comparison with the achievement of the purpose of punishment. The solution of this problem requires the consolidation of the imperative requirement of mandatory compliance with medical protocols during the treatment of convicts, including compliance with deadlines for examination of convicts, the obligation to provide them with assistance and other mandatory algorithms. This should be complemented by the formulation of a doctrinal provision on the priority of the life and health of the convict over the achievement of the purpose of punishment. This means that the provision of medical care and treatment to sick convicts and detainees must be unquestionable. The rule on optimal continuity of medical care, in particular, ensuring such continuity during the staging of convicts, their transfer from institution to institution, etc., requires imperative consolidation. Compliance with the requirements for consistency, timeliness and intensity of treatment should be the main norm in matters of medical services for convicts and detainees. Normative legal acts regulating the procedure and peculiarities of providing medical care to convicts and detainees in procedural issues should be deprived of excessive discretion, which is inherent in many by-laws in the field of execution of criminal punishments.

7.    Mutual mistrust between convicts/prisoners and SCES staff. Overcoming this mistrust, unfortunately, cannot be achieved in a short time. Only the creation of a positive climate in penitentiaries, humane treatment of convicts, giving them the opportunity to communicate in confidence with psychologists, medical workers, religious workers, guaranteeing the existence and preservation of medical secrets, secrecy of confession, etc., can gradually remove the obvious general confrontation. setting up a proper atmosphere inside penitentiaries. Introduction of an independent and efficient medical service increases the chances of changing the general settings of the entire penitentiary system.

8.    Lack of special regulations and understanding of the need for separate approaches to convicts with special needs. The problem is solved by adopting relevant regulations and regulating the mechanisms for implementing them. In addition, in order to work with such convicts, it is necessary to solve the above-mentioned problems, as the qualified staff, provision and support of such convicts are needed, ensuring their uninterrupted treatment (therapy) and care.

 How to integrate penitentiary medicine into civilian medicine?

One suggestion to reform penitentiary medicine is to “integrate” detainees into the existing e-health system with its family physicians and other appealing programs. This algorithm involves the liquidation of the State Institution “HC of SCES” and the complete transfer of its functions to the relevant institutions of the MoH. This is the most “painless” way that does not require excessive effort, but also does not solve the problems that exist in the field of medical services for convicts and detainees.

Therefore, when determining the ways of reform, it is necessary to constantly keep in mind the problems that, in fact, caused the need to transform the medical sphere in places of detention.

Regarding the reform by transferring the functions of providing medical care to the Ministry of Health and “adding” detainees in the places of detention to the general e-health system, we believe that the “family” doctor in a penitentiary institution is a non-working myth. And that’s why:

-   The e-health system assumes that every client has the technical capability, time and free will in order to make an appointment with a doctor and wait in a significant queue, get a brief consultation and be included into the various electronic forms that doctors fill out. Unfortunately, persons held in places of detention do not have any of the above features and capabilities. Thus, at this stage, the chance of their communication with the doctor will depend entirely on the administration of the penitentiary institution and the availability of free time of the “family” doctor, who, in addition to convicts and detainees, must also receive other patients. The situation is complicated by a purely technical issue – personal contact with a doctor. The creation of an effective mechanism of a “meeting” between those persons remains questionable;

-  The e-health system assumes that after the initial admission, each client has the technical ability, time and free will to continue to follow the doctor's recommendations. If a convict or detainee finds himself in need of secondary medical care, he will have to find an opportunity to go to a specialized hospital (go there and possibly stay to receive inpatient care. And in general be able to move quite quickly). Persons held in places of detention do not have such opportunities. They cannot promptly follow the doctor’s recommendations, and deciding whether to transport them to a specialized hospital and leave them there for care in general is a complex process with a large number of unknown factors. It is impossible to guarantee such opportunities, given the significant physical distance between the convict and the doctor. Therefore, such an algorithm does not solve the problem of access to the doctor.

-  The e-health system assumes that every “family” doctor is interested in providing services to those persons with whom a declaration has been concluded. Here difficulties arise even at the stage of concluding declarations. Not all convicts and prisoners have them, and for those who do, it will be necessary to re-declare, as the person may change their location due to placement in a penitentiary institution. Questions arise: first, who will coordinate the declaration process? The administration? In this case, the provision of medical care will be made dependent on the will of the administration at the stage of its documentation. Given the current medical records in the penitentiary system, it is not to be expected that the organization of declarations will be of better quality. In addition, there is a problem with the lack of documents of many persons held in places of detention. In this case, the conclusion of the declaration will be impossible. Secondly, even if one is to imagine that the declarations are concluded, the organization of the process of direct contact with the doctor is a big question. How to organize these contacts? Will the doctor visit the place of detention on schedule? This means that prisoners also need to be sick on schedule. And this means that the doctor will have to cancel the reception of other citizens with whom he also has declarations several times a week/month. Given the current state of medical care in conventional hospitals, it is difficult to imagine what the process of providing such medical care will be like after the convicts are added. Queues will increase, the number of electronic documents will increase, the need to make decisions about treatment will be more acute. The burden on the doctor will increase, and there will be no compensation for the doctor, because those are “normal” patients. Add to this the fact that several doctors will probably visit one penitentiary institution, as the principle of service is “declarative”. It is quite possible that a doctor will be in the penitentiary institution every day, but he will provide assistance only to “his” clients.

If we add to this the lack of Internet access for convicts and detainees in most institutions, as well as the fact that any use of the network is possible only with the permission of the administration and subject to payment by the prisoner, we get a lot of prerequisites to see a doctor and full control over access to the doctor by the administration.

And this is only part of the difficulties that lie on the surface. Most problems are still “invisible”.

As we can see, the existing system of medical care for free citizens is completely unsuitable for its implementation in places of detention, because it does not solve the problems that exist today, but only creates new ones.

The world practice of ensuring the right of convicts to medical care has developed the following criteria for adequate medical care:

1)   clear delineation of competencies of medical staff and administration of institutions, prevention of influence of the administration on medical staff in matters of providing medical care to prisoners and recording of their bodily injuries;

2)   ensuring unimpeded access of prisoners to medical staff;

3)    strict observance of medical secrecy concerning the state of health of prisoners, in particular in relation to the administration of institutions, and on the other hand, the right of prisoners to receive reliable and complete information about the state of their health;

4)   providing detailed documentation of the prisoner’s state of health and treatment during detention;

5)   promptness and accuracy of diagnosis and treatment;

6)   regular and systematic supervision and availability of a plan of therapeutic measures to treat the prisoner’s illnesses or prevent their complication;

7)   creating the conditions necessary for the actual provision of the prescribed treatment;

8)   the duty of the state to cure a seriously ill prisoner is the duty to take the means, not to achieve the result (criterion of due diligence).

When reforming penitentiary medicine, these criteria should always be in the field of view of both SCES staff and medical staff involved in the treatment of convicts and prisoners.

Based on the above, we can formulate the goal of reforming penitentiary medicine – to create an independent (from the Ministry of Justice and SCES), accessible, prompt, effective and mobile medical service for convicts and detainees, which can provide a full range of medical services. In our opinion, this should be a separate unit of the Ministry of Health.

Algorithm of transfer of infrastructure and organizational subordination of the medical units and institutions of SI “HC of SCES” to the Ministry of Health

Today, the issue of the need to subordinate the penitentiary medicine to the Ministry of Health seems to have been resolved. Both the Ministry of Justice, the SCES and the Ministry of Health are well aware of the problems and have a common position on the need to transfer this area of medical activity to the Ministry of Health.

At the same time, those departments lack unity in the issues of the mechanism of transfer and the algorithm of the subsequent work of the penitentiary medicine.

Understanding the departmental and administrative complexity and multi-vector nature of the problem, we offer our own vision of the order and sequence of actions necessary for the organization of the transfer of penitentiary medicine and its further operation under the leadership of the Ministry of Health of Ukraine. 

We believe that the idea of creating a separate structural unit within the Ministry of Health of Ukraine, which will only be tasked with medical care for convicts and detainees, is the most expedient, efficient and capable of eliminating the existing problems in the field of medical care for persons in places of detention.

The following stages are necessary to implement such idea.

1.    Decision-making stage. At this stage, mutual agreement is needed between the Ministry of Justice, the Ministry of Health and the SCES on the procedure and sequence of actions for the transfer of health care (political will and willingness to constructive compromise).

2.    Coordinating the sequence of actions. In accordance with the accepted concept of concluding a memorandum (or without it) on the general conditions and procedure for the transfer of medical infrastructure from one department to another. It is advisable to create a working group that will be able to quickly and purposefully work on the development of a holistic transmission algorithm and its individual components. 

3.    Adoption of a concept of health care reform, which would define the existing issues and the ways to remove them, the general aim of the reform and the main constitutional idea of provision of medical services: creation of a separate structural unit within the structure of the Ministry of Health of Ukraine, which will only be tasked with medical care for convicts and detainees (the algorithm of this unit is described in paragraph 8). 

4.    Adoption of regulations (amendments to the CEC, Internal Schedule Rules, a separate order on the provision of medical care and a number of regulations that determine the procedure for actions related to the provision of medical services to convicts and detainees). These regulations should contain general principles of medical care, the procedure for providing primary care services (examination, diagnosis, counselling, secondary care, placement of patients in medical institutions for inpatient treatment, treatment of dangerous diseases and special conditions (tuberculosis, HIV, alcoholism, drug addiction, etc.), special cases of medical care or supervision – treatment of the disabled, pregnancy and childbirth, etc.). Mandatory provisions of the acts should include the availability of guarantees for the independence of the medical workers, as well as liability for failure to provide or untimely provision of care and poor quality of medical care. Regulations should contain links and connection to national programs of medical guarantees and available medicines, etc. 

5.    Dismissal of medical staff of the HC of SCES (or transfer due to the reorganization of the department) and their employment in medical institutions of the Ministry of Health (created on the basis of institutions of the HC of SCES or other institutions of the Ministry of Health). 

6.    Creation of the infrastructure of medical institutions serving convicts and prisoners, liquidated by the State Institution “HC of SCES” on the basis of medical institutions. To this end, the transfer of institutions, property and equipment to the Ministry of Health on the transfer balance and act with the simultaneous creation of a separate structural unit – the medical service of places of detention. Introduction of the procedure of reorganization/liquidation of the State Institution “HC of SCES” by conducting an inventory, audit, drawing up a transfer balance, etc. and further transfer of property to the Ministry of Health. Medical workers dismissed from the SI “HC of SCES” (at their request) are employed in the specified institutions. Involvement of individual entrepreneur medical workers who will be able to provide medical services on the basis of contracts concluded directly with the SCES. Procurement of medical services for SCES under the simplified public procurement procedure (introduction of the criterion – medical care for convicts and prisoners – and setting a cost limit for such services – no more than UAH 350,000 per year (for individual entrepreneurs)).

In order to ensure the work of the medical units of the penitentiary system, transferring individual staff to them to provide medical care to convicts and detainees in their places of imprisonment/detention. In this case, the subordination, financing and management of the activities of the medical workers is carried out by the Ministry of Health (or, if they are individual entrepreneurs, respectively, they operate independently). To this end, medical units are organized in the penitentiary institutions, which provide primary care, diagnosis, counselling, fixation of injuries, outpatient treatment. The premises of the medical units belong to the penitentiary institutions and are leased to the Ministry of Health. Settlement of issues of providing premises for doctors and other medical staff of the Ministry of Health for placement of medical units in the penitentiary institutions and material support of these medical units by the Ministry of Health (premises are leased by SCES, material support is provided by the Ministry of Health). 

7.    Addressing the issue of remuneration of future employees of medical units in the penitentiary. This direction of reform should include measures that motivate health workers to work in the system of medical care for convicts and detainees. Given the trend of dismissal of health workers from the system of state and municipal institutions, it is necessary to introduce a system of material incentives and social protection of health workers. The wage system must have a guaranteed system of surcharges and allowances for work in difficult conditions and the stressful nature of work. Adoption of relevant regulations. 

8.    Organization of the work of the medical service of the MoH in the penitentiary institutions and the entire structural unit of the Ministry of Health:

Convicts and prisoners sent to penitentiaries and pre-trial detention centres are accounted for and registered in e-health. To do this, a separate module is created in the system, which is synchronized with the Unified Register of Convicts. It is impossible to enter information about a convict in this register without creating a medical declaration.

The drawing up of a medical declaration must take into account the absence of identity documents of a convict or detainee.

All declarations are accounted for and managed in this module exclusively by those health workers who work in the structural unit of the MoH, which takes care of the penitentiary institutions and pre-trial detention centres.

Doctors who treat convicts and prisoners are “family” doctors exclusively for these people. There are no other persons among their clients (patients).

The system allows convicts and prisoners to access all national medical programs.

The treatment is carried out in compliance with all norms, standards and requirements that exist in civilian medicine. Priority is given to treatment measures over security measures. 

The system of medical institutions that are created to treat convicts and detainees is based on the facilities of the liquidated State Institution “HC of SCES”. The provision and financing of these institutions should create conditions for their maximum capacity (they should be able to provide the full range of medical services, have specialists of various specializations, appropriate equipment) in order to reduce the need to send convicts to other medical institutions. However, such cases (referrals to other institutions) should not be ruled out. Their possibility is provided by the requirements of treatment and is regulated by regulations and routes of movement of convicts and prisoners.

The general algorithm of activity of the medical service is the following.

A convict receives the full range of primary care (including outpatient treatment and counselling), basic diagnostic services and the opportunity to be tested in the medical units of the penitentiary.

If it is necessary to hospitalize the convict, he is sent to the institutions that are part of the structural unit of the MoH (the 16 hospitals of the HC of SCES, which we propose to transfer to the MoH). If it is necessary to place a convict or prisoner in an institution under the supervision of specialists who are not in the structural unit or if the patient’s condition requires services that can not be provided by the structural unit, the convict or prisoner is sent to another MoH institution according to the doctor’s recommendations.

The protection, supervision and movement of convicts and detainees is carried out by the SCES.

Medical institutions of the structural unit are equipped with appropriate material and technical means of protection and supervision. In the case of placement of convicts or detainees in other institutions, the protection, supervision and isolation of such persons in each case is provided based on the patient’s health, material and technical capabilities of the institution and the capacity of the SCES.

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