European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) Strasbourg, 21 August 2017 CPT/Inf (2017) 20 (Former CPT (2010) 102 REV) Inspection of a prison medical service by a CPT doctor Checklist This list is not exhaustive, but rather a tool to be used during CPT visits, and will be reviewed on a regular basis. I. Initial interview with the doctor in charge Questions to raise (keep in mind the following general areas of concern): 1. Access to a doctor, 2. Equivalence of care (with special attention to the higher morbidity and the greater health-care needs of prisoners), 3. Patient's consent and confidentiality, 4. Preventive health care (vaccination, addiction, opiate substitution, condoms, needle and syringe exchange, etc.), 5. Vulnerable inmates: elderly, women, disabled, LGBT, juveniles, ethnic minorities, undocumented foreign nationals, 6. Professional independence, 7. Professional competence A. Medical/nursing team ▪ ▪ ▪ ▪ B. Number of doctors (GPs, psychiatrists, dentists), other specialists, psychologists, nurses, auxiliaries (full-time/part-time; other employment) in relation to the number of inmates Presence of staff in prison (times of arrival and departure) Training, qualifications, remuneration terms Involvement of third parties in care: guards, prisoners? Outside medical support ▪ ▪ ▪ Back-up hospitals for emergencies/serious conditions? Specialist outside consultations (what, who, when, number?) Method and conditions of medical transfer of sick prisoners (in particular, emergency cases) C. Medical care work 1) Volume ▪ Transmission of health care information / continuity of care ▪ New prisoners: number per month, content/moment of medical examination upon admission ▪ Consultations during imprisonment: availability, number and duration of consultations by type of health-care staff, access arrangements respecting confidentiality (oral/written requests, giving reasons for requests to non-medical staff, filtering of requests - by whom?)? ▪ Waiting times by type of health-care service ▪ Emergencies: procedure during/outside working hours; medical staff on call in prison: who? ▪ Care provided free of charge / copayment by prisoners? health insurance? ▪ Medical service also responsible for prison staff/families? 2) Ailments encountered ▪ Type / specific ailments encountered by the service ▪ Gender sensitive health care and prevention (pregnant women / mothers and infants / screening for sexual abuse and other forms of violence / screening for breast and gynaecological cancer) ▪ Groups with special needs: e.g. disabled / LGBT / elderly ▪ Mental disorders (psychotic disorders, consent to treatment, use of seclusion and restraint) ▪ List of deaths: causes, autopsies conducted? 3) Prevention, addiction and harm reduction ▪ Suicide prevention, self-harming ▪ Transmissible diseases (e.g. Hepatitis, HIV, TB, syphilis, skin infections): screening, counselling, prevention, follow up and treatment ▪ Condom distribution in a confidential manner? ▪ Prevention of transmission of diseases through tattooing, piercing and other forms of skin penetration ▪ Systematic screening for drug, alcohol and tobacco use/abuse upon entry? ▪ Drug testing (type of tests used, reference lab for supervision?) ▪ Is opiate substitution treatment offered to prisoners and under what conditions (free of charge / exclusion of undocumented foreign nationals / confidentiality)? ▪ Are needles and/or syringes found during cell searches? Frequency of needle- and syringerelated problems? Needle and syringe exchange programs (NSP) in the community/in prison?

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