CAT/OP/PER/1 48. The Subcommittee recommends that the prison authorities and the Ministry of Health immediately conduct an assessment of existing health services in prisons, followed by the necessary reforms to guarantee facilities and services of equivalent quality to those available to the general public. Each prison should have a doctor in attendance on a daily basis, which means doctors must be assigned as a matter of urgency to those prisons where there is currently no doctor at all. Women’s prisons should have a gynaecologist and a paediatrician on site. Appropriate pay and working conditions should be guaranteed for medical staff so as to attract qualified professionals. Prison health issues cannot be the sole responsibility of the National Prison Institute, but must also be addressed by the Ministry of Health. 49. The Subcommittee observed that specialist care is inadequate and that the procedure for obtaining it is long and complex, as it requires prior approval by a medical board. Moreover, the practice of transferring patients to hospitals with security staff poses logistical challenges, not to mention the financial difficulties faced by patients who are not covered by the Comprehensive Health Insurance (SIS) system and have to pay for their consultations and treatment. Some prisoners recounted how deaths had occurred for lack of timely specialized care due to excessive processing delays. 50. Prisoners should be able to seek professional medical assistance in confidence and without their request being obstructed or filtered by guards or other prisoners. All forms of medical care should be free of charge. Access to prescription medicines, and their prompt delivery to patients, must be guaranteed; the same applies to any medical tests and examinations they may need. 51. The Subcommittee recommends that the criteria for SIS coverage should be modified as soon as possible so that all persons deprived of their liberty may access the system and enjoy the same benefits as persons at liberty who are members of the system. 52. The Subcommittee recommends making agreements with hospitals for specialists to visit prisons to examine persons deprived of their liberty who are in need of specialized care. 53. In the Chorrillos I prison, the Subcommittee observed that psychopharmacological drugs are being administered to 48 persons deprived of their liberty. Monitoring, however, is left to a nurse, as the psychiatrist only visits the prison twice a month. In the Chorrillos annex the Subcommittee received complaints that the authorities administer psychopharmacological drugs to persons deprived of their liberty as a matter of course, without any proper individual psychiatric assessment or monitoring. 54. The Subcommittee recommends close monitoring by specialists for persons deprived of their liberty who are given psychopharmacological drugs. 55. The Subcommittee saw that the capacity to diagnose and prevent the spread of tuberculosis in large prisons is grossly inadequate. In the Lurigancho prison, the wing for patients with drug-resistant and multi-drug-resistant tuberculosis is in a deplorable state of repair. 56. The Subcommittee recommends that the Ministry of Health conduct a study on the extent of the tuberculosis epidemic in prisons and provide clear guidelines on the detection, diagnosis, containment and prevention of transmission of tuberculosis among persons deprived of their liberty, staff and visitors. The wing for tuberculosis sufferers in Lurigancho should be renovated. Chest X-ray machines should be installed in all large prisons, and access to X-ray facilities should be ensured in small prisons. 57. The Subcommittee found that in many cases medical examinations are conducted in front of prison staff. In addition, due to a lack of health workers, security officers of the National Prison Institute also assist in first aid stations and consequently have access to medical records. 58. The Subcommittee wishes to remind the State party that medical confidentiality must be fully respected in all places of deprivation of liberty. GE.17-13638 9