Protection of Healthcare in Penitentiary System and Torture Prevention Mechanisms Medicaiton provision and operation of a pharmacy Herewith we stress that in recent years finances allocated for medications have increased significantly though centralized distribution of medications to separate organizations creates problems for timely and adequate medical service and causes prisoners’ discontent. During the monitoring it was revealed that by the end of the year medication shortage and majority of those interviewed noted that often they were provided with the necessary medications by their family members or they used to buy them in a pharmacy located on the territory of their establishment. Sphere specialists mainly handled activities, typical for pharmacies in medical units. Starting from the second half of 2010 pharmacies’ names were changed into “medication provisions“ while personnel – “person responsible for medication provision “. Against the background of such tendencies, even a person without special pharmaceutical education can be appointed on the above position which is already a step behind. Based on the principle of timely and adequate provision of medical service and equivalence, it is recommended that provision with necessary medications be done on the basis of decentralization, on spot administration and management, while the medical department to implement evaluation and monitoring. Referral programme Referral medical programme is implemented and administered in the Georgian penitentiary system by the same medical department on the basis of an agreement with various hospitals of civil sector. Although, by the end of 2012 because of conclusion of new agreements there was a delay in timely conduction of medical examinations was hampered. It shall be noted that in the format of referral programme expensive medical examinations and in-patient department are being done though due to the centralization of the administration the question of timely promptness and proximity of medical service remains a problem. Accordingly, as in the case of provision of medications it is recommended the referral proragamme to be implemented on the spot and evaluation and monitoring of the question to be carried out by the central managment. Medical infrastructure It shall be noted that infrastructure of psychiatric department of the medical establishments for defendants and convicts does not comply with requirement standards and therefore non-voluntary treatment of a patient cannot be carried out in the said establishments. Transfer of mentally ill patients to civilian psychiatric hospitals is also problematic 31 7 December 2010 Order #398/n of the Minister of Labor, Health and Social Welfare of Georgia on the “Approval of Form and Rule of Mandatory Notification for Providers of High Risk Medical Activity/Service to be Carried Out in Outpatient/Day Clinic Conditions and the Procedure for Administration of Register”; NPM Report 2012 It shall be noted that the Georgian penitentiary system where in 2012 there were 23 160 prisoners, was served by just one medical establishment which in the list of penal establishments is listed as N18 establishment of the penitentiary department and is designed for male in-patient service as well as medical and rehabilitation centre for tuberculosis sufferers (N19 establishment of the penitentiary department) that was in a deplorable state in respect of its infrastructure and service resources and to which a new block was added by the end of the year. Thus, improvement of the mentioned services is to be expected by 2013. In the majority of the penitentiary establishments there are attempts to improve a primary care component (in sepearte establishments: N2, N5, N6, N8, N9, N12, N15, N17 centres of primary healthcare were opened and equipped), also ambulatory component with elements of the secondary healthcare (with mini-in-patient units) though location and infrastructure of the said units in the newly-built establishments practically represent wards or rooms designed for medical purposes and are located in prison cells that does not correspond to organizational aspects of the in-patient and ambulatory type establishments and creates risks for violation of sanitary and hygiene norms.31 At the same time, it does not prepare psychologically patient and doctor for activities of medical character, which puts principles of protection of ethical standards under threat.