2. Prisons and secure preventive detention Importance of the healthcare service for prevention and detection of ill-treatment Since 2017, we have been constantly pointing out shortcomings in the legal framework and practical measures ensuring that the healthcare service (not only in prisons) performs its role in effective documentation and investigation of ill-treatment of persons deprived of liberty. Indeed, recommendations of the CPT regarding documentation and reporting of medical findings and ensuring confidentiality of medical examinations have yet to be implemented. When investigating three individual complaints filed by prisoners, the Defender found specific shortcomings in practice which frustrated effective investigation of alleged ill-treatment in 2019. In order to explain the problem, we organised a seminar for public prosecutors and medical professionals working in prisons in 2019 in co-operation with the Supreme Prosecutor General’s Office and the Judicial Academy. Subsequently, we initiated negotiations with the Ministry of Health and the Ministry of Justice to convince them to provide for remedy. Within the dialogue with the CPT, the Government has already promised to take the first steps. 2019 CPT report and the Government’s response Defender’s report on inquiry into the prisoner’s complaint Standard for the activities of physicians in prevention of ill-treatment The prohibition of ill-treatment implies the duty of the State to prevent and punish such treatment, protect potential victims, and effectively investigate cases where there is a suspicion of ill-treatment. These obligations are even stricter in cases where the victim is deprived of liberty. Standards for the role of physicians in prevention and detection of ill-treatment are included in: UN principles for effective investigation and documentation of ill-treatment; Istanbul Protocol, i.e. the UN principles implementation manual; CPT standard for documenting and reporting medical evidence of ill-treatment. A physician’s role is irreplaceable when he/she is examining or treating a person bearing signs of possible ill-treatment (assault by a fellow prisoner, inappropriate use of force by a police officer or a prison officer) or a person who complains about ill-treatment directly. The system must be set up so that, in such cases: ― the medical examination is carried out confidentially, without the presence of police officers or guards (with certain exceptions); ― the physician’s report includes (i) the most accurate description of events, ill-treatment and subsequent physical and mental manifestations, as stated by the patient; (ii) a full account of medical and psychological findings, including colour photographs of injuries; (iii) a physician’s opinion as to the likely connection of the findings and possible torture and ill-treatment, and any recommendations for further care; ― the physician can, and is required to, systematically report such cases to the authorities competent to investigate. To remove systemic obstacles, it is necessary... Ministry of Health: to prepare an amendment to the Healthcare Services Act so that notification of findings of signs of ill-treatment does not constitute a breach of the physician’s confidentiality and that the presence of prison guards is not required during medical examinations and treatment of prisoners. Ministry of Justice: to ensure methodological guidance and education of prison physicians and the necessary conditions for their work. 11