taken place a few weeks prior to the visit. No medical file for that prisoner existed. The SPT is of the opinion that this example illustrates that the chain of command for prisoners to see a doctor is working in an inappropriate manner. The SPT strongly recommends that any medical gate-keeping function is taken on by staff with appropriate medical training, e.g. nurses. 230.Furthermore, the delegation was informed that in the clinic of Maafushi prison, medical interviews and examinations were carried out in the presence of two prison officers, and understood that medical examinations of prisoners from Unit 1 took place in the presence of prison officers, and the prisoner was also held handcuffed. The prison doctors also informed the delegation that they had noticed that patients with physical injuries often refused to tell the origin of the lesions. This may very well be the result of officers being present at the examination. In Maafushi Prison, it also appeared that non-medical staff had access to the medical records of the prisoners. 231. The SPT recommends that the authorities ensure that medical confidentiality is scrupulously respected at all times The SPT emphasizes that prison officers should stay out of hearing and preferably out of sight of the patient during his/her interaction with the doctor. In exceptional cases, where a doctor so requests, special security arrangements may be considered relevant, such as having a prison officer within call. The doctor should note this assessment in the record together with a description of security measures taken and the names of all persons present. Furthermore, non-medical staff should not be allowed access to the medical records. 232.The delegation found that in some cases, although the prisoner had been examined and treated, the medical record was of poor quality with omission of essential data; in one case no medical record even existed. The SPT underlines that good record keeping is an essential part of the medical element in the protection of the physical integrity of persons deprived of their liberty. All cases of injuries should be registered, not only in the patient ’ s individual case record, but also in an incident register that should go to the director. 233.The SPT considers that prisoners in unit 1 are kept under conditions that equal those in a punishment unit; hence, the SPT recommends that the healthcare staff of the prison should perform daily checks on their health, it being understood that the doctor should act, as always, in the best interests of the health of the prisoner. (a)HIV and drug testing in prisons and treatment offered for substance abusers 234.The Medical Committee for Maafushi Prison informed the delegation that routine compulsory testing for HIV or drugs is not done; only three HIV positive prisoners were identified so far in the Maldives. However, there were plans to introduce such testing in the future. The SPT requests the authorities to provide information concerning the practical modalities of those tests. 235.The SPT was informed that there were no specific treatment regimes for drug abusers. It was also informed that illegal drugs were abundantly available in the prison. Considering that the vast majority of prisoners were sentenced for drug related crimes, authorities should introduce programmes for treatment and rehabilitation of drug abusers, not only to mitigate individual suffering, but also with a view to reducing the demand for the illegal traffic. Members of the delegation were informed that the United Nations Office on Drugs and Crime, UNODC, is launching programme 71 aimed at drug-prevention policy in prisons, and awareness raising programmes are also envisaged. The SPT requests the authorities for updated information about the development of these programmes . (b)Training of medical staff 236.The delegation was informed that the medical staff have had no training in health issues related to prison, e.g. human rights and medical ethics, public health and hygiene, infectious diseases, epidemics and forensic assessment and description of traumatic lesions. Considering the difficulties in recruitment and the high turn over of medical doctors of the prison, the SPT recommends that the medical staff, particularly the doctors, should be given refresher courses in relevant topics on a regular basis. Medical staff did not participate in the oversight of hygiene and quality of food and prison regimes in terms of the impact on health. The SPT recommends that medical doctors, after appropriate training, should be involved in these responsibilities. (c)Psychiatric patients in prison 237.The delegation members interviewed prisoners in Maafushi Prison and in Malé Remand Centre who had longstanding psychiatric conditions, including in the period of offences. The SPT notes that the Maldives do not have mental health legislation and no specialized facility to keep psychiatric offenders. The SPT recommends that the Maldivian authorities adopt mental health legislation to ensure that deprivation of liberty of persons suffering of psychiatric conditions is given a firm legal basis. If a specialized facility is not established, it should be ensured that all psychiatric offenders serving long term sentences are attended on a regular basis preferably with continuity of care provided by the same psychiatrist. 16. Allegations of physical ill-treatment and corroborative findings 238.The visiting delegation heard a number of allegations of physical ill-treatment by prison officers, in particular from the prisoners held in unit 1. The nature of the alleged ill-treatment was similar in both establishments visited: punches and kicks by prison officers inflicted upon handcuffed prisoners and fixation of the body in awkward positions with handcuffs for prolonged periods of time. The multiple lesions assessed by the medical members of the delegation were, by their age, shape, and location, found to be in full agreement with the allegations. In addition, the delegation was informed by the female prisoners that on one occasion those female prisoners who complained about lack of work in the