National Preventive Mechanism Individual observations led to the conclusion that inmates in need of nursing care do not receive adequate instructions or active support from the nursing staff for their everyday care needs. Geriatric department The NPM considers it extremely disturbing that a detainee who suffered from faecal incontinence and had had an artificial outlet for the bowels for a long time received no instructions and no help with stoma care from the nursing staff. Rather the inmate relied on the support from fellow inmates. Inmates wasting away Another prisoner in a wheelchair was encountered. According to him, he had had a permanent catheter for five months. The urination did not function. According to the commission’s visit report, a suprapubic catheter “had not yet been considered”. Although he himself did not receive any help to mobilise, he attempted to help fellow prisoners, e.g. in changing incontinence pads. A third inmate showed clear signs of severe Alzheimer’s dementia with tremors. He was also spatially and temporally disoriented. Overall, the visit to the special medical facility raised doubts as to whether the nursing care was conscientious and caring. Statements heard and entries in the medical records – such as “needs nappies” or “pesters the doctors and nurses all night” – suggest a contemptuous attitude of the staff toward the inmates and a dubious understanding of nursing care. Lack of empathy As the institution’s physician admitted, he hardly visits the inmate cells due to lack of time. Due to the organisational overload, there is also too little time to speak with individual patients. Lack of time With respect to the need for additional nursing staff, the Federal Ministry of Justice stated that it was making an intensive effort to ensure comprehensive care to all inmates even when there are absences due to holidays or illnesses. The Federal Ministry of Justice rejected the criticism of nursing and medical care. It said that each of the inmates housed in the special medical facility received appropriate care because the nursing staff was on duty 24 hours a day. With respect to the individual findings mentioned, it was said that the appropriate treatment had been given and directives had been issued. How the healthcare and nursing care is ensured to inmates not housed in the special medical facility but who nevertheless have a great need for nursing care remains an open question. The statements of the Federal Ministry of Justice are difficult to reconcile with the observations made by the commission. Even though the NPM cannot yet make a definitive assessment on the basis of the information available: the fact that inmates with an acute need for nursing services for their daily physical tasks must rely on assistance from fellow inmates – due to a lack of capacity or support from the nursing staff – is completely unacceptable. Preliminary review 155